腔隙性卒中早期神经功能恶化的挽救治疗。

Rescue therapy of early neurological deterioration in lacunar stroke.

机构信息

Department of Neurology, SoonChunHyang University Hospital Seoul, Seoul, Republic of Korea.

Department of Neurology, Inha University School of Medicine, Incheon, Republic of Korea.

出版信息

BMC Neurol. 2024 Sep 7;24(1):329. doi: 10.1186/s12883-024-03825-7.

DOI:10.1186/s12883-024-03825-7

PMID:39244562

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11380375/

Abstract

BACKGROUND

Early neurological deterioration (END) occurs in many patients with acute ischemic stroke due to a variety of causes. Although pharmacologically induced hypertension (PIH) and anticoagulants have been investigated in several clinical trials for the treatment of END, the efficacy and safety of these treatments remain unclear. Here, we investigated whether PIH or anticoagulation is better as a rescue therapy for the progression of END in patients with lacunar stroke.

METHODS

This study included patients with lacunar stroke who received rescue therapy with END within 3 days of symptom onset between April 2014 and August 2021. In the PIH group, phenylephrine was administered intravenously for 24 h and slowly tapered when symptoms improved or after 5 days of PIH. In the anticoagulation group, argatroban was administered continuously intravenously for 2 days and twice daily for next 5 days. We compared END recovery, defined as improvement in NIHSS from baseline, excellent outcomes (0 or 1 mRS at 3 months), and safety profile.

RESULTS

Among the 4818 patients with the lacunar stroke, END occurred in 147 patients. Seventy-nine patients with END received PIH (46.9%) and 68 patients (46.3%) received anticoagulation therapy. There was no significant difference in age (P = 0.82) and sex (P = 0.87) between the two groups. Compared to the anticoagulation group, the PIH group had a higher incidence of END recovery (77.2% vs. 51.5%, P < 0.01) and excellent outcomes (34.2% vs. 16.2%, P = 0.04). PIH was associated with END (HR 2.49; 95% CI 1.06-5.81, P = 0.04). PIH remained associated with END recovery (adjusted HR 3.91; 95% CI 1.19-12.90, P = 0.02). Safety outcomes, like hemorrhagic conversion and mortality, were not significantly different between the two groups.

CONCLUSIONS

As a rescue therapy for the progression of END in lacunar stroke patients, PIH with phenylephrine was more effective with similar safety compared to anticoagulation with argatroban.

摘要

背景

许多急性缺血性脑卒中患者因多种原因出现早期神经功能恶化（END）。虽然几项临床试验已经研究了药物诱导的高血压（PIH）和抗凝剂治疗 END 的疗效，但这些治疗的疗效和安全性仍不清楚。在这里，我们研究了 PIH 或抗凝剂作为腔隙性卒中患者 END 进展的挽救性治疗是否更好。

方法

本研究纳入了 2014 年 4 月至 2021 年 8 月期间发病后 3 天内接受 END 挽救治疗的腔隙性卒中患者。在 PIH 组中，静脉注射苯肾上腺素 24 小时，症状改善或 PIH 后 5 天逐渐减量。在抗凝组中，连续静脉滴注阿加曲班 2 天，然后每天两次连续使用 5 天。我们比较了 END 恢复，定义为 NIHSS 基线改善，良好结局（3 个月时 0 或 1 mRS）和安全性。

结果

在 4818 例腔隙性卒中患者中，有 147 例发生 END。79 例 END 患者接受 PIH（46.9%），68 例（46.3%）接受抗凝治疗。两组间年龄（P=0.82）和性别（P=0.87）无显著差异。与抗凝组相比，PIH 组 END 恢复发生率更高（77.2% vs. 51.5%，P<0.01）和良好结局发生率更高（34.2% vs. 16.2%，P=0.04）。PIH 与 END 相关（HR 2.49；95%CI 1.06-5.81，P=0.04）。PIH 仍与 END 恢复相关（调整后的 HR 3.91；95%CI 1.19-12.90，P=0.02）。两组间出血性转化和死亡率等安全性结局无显著差异。