Gurwitz J H, Gore J M, Goldberg R J, Barron H V, Breen T, Rundle A C, Sloan M A, French W, Rogers W J
University of Massachusetts Medical School and the Fallon Healthcare System, Worcester 01608, USA.
Ann Intern Med. 1998 Oct 15;129(8):597-604. doi: 10.7326/0003-4819-129-8-199810150-00002.
The efficacy of thrombolytic therapy in reducing mortality from acute myocardial infarction has been unequivocally shown. However, thrombolysis is related to bleeding complications, including intracranial hemorrhage.
To determine the frequency of and risk factors for intracranial hemorrhage after recombinant tissue-type plasminogen activator (tPA) given for acute myocardial infarction in patients receiving usual care.
Large national registry of patients who have had acute myocardial infarction.
1484 U.S. hospitals.
71073 patients who had had acute myocardial infarction from 1 June 1994 to 30 September 1996, received tPA as the initial reperfusion strategy, and did not receive a second dose of any thrombolytic agent.
Intracranial hemorrhage confirmed by computed tomography or magnetic resonance imaging.
673 patients (0.95%) were reported to have had intracranial hemorrhage during hospitalization for acute myocardial infarction; 625 patients (0.88%) had the event confirmed by computed tomography or magnetic resonance imaging. Of the 625 patients with confirmed intracranial hemorrhage, 331 (53%) died during hospitalization. An additional 158 patients (25.3%) who survived to hospital discharge had residual neurologic deficit. In multivariable models for the main effects of candidate risk factors, older age, female sex, black ethnicity, systolic blood pressure of 140 mm Hg or more, diastolic blood pressure of 100 mm Hg or more, history of stroke, tPA dose more than 1.5 mg/kg, and lower body weight were significantly associated with intracranial hemorrhage.
Intracranial hemorrhage is a rare but serious complication of tPA in patients with acute myocardial infarction. Appropriate drug dosing may reduce the risk for this complication. Other therapies, such as primary coronary angioplasty, may be preferable in patients with acute myocardial infarction who have a history of stroke.
溶栓治疗降低急性心肌梗死死亡率的疗效已得到明确证实。然而，溶栓与出血并发症相关，包括颅内出血。
确定在接受常规治疗的急性心肌梗死患者中，使用重组组织型纤溶酶原激活剂（tPA）后颅内出血的发生率及危险因素。
对急性心肌梗死患者进行大型全国性登记研究。
美国1484家医院。
1994年6月1日至1996年9月30日期间发生急性心肌梗死、将tPA作为初始再灌注策略且未接受第二剂任何溶栓剂的71073例患者。
通过计算机断层扫描或磁共振成像确诊的颅内出血。
据报告，673例患者（0.95%）在急性心肌梗死住院期间发生颅内出血；625例患者（0.88%）经计算机断层扫描或磁共振成像确诊该事件。在625例确诊颅内出血的患者中，331例（53%）在住院期间死亡。另外158例存活至出院的患者（25.3%）有残留神经功能缺损。在候选危险因素主要效应的多变量模型中，年龄较大、女性、黑人种族、收缩压140 mmHg或更高、舒张压100 mmHg或更高、中风病史、tPA剂量超过1.5 mg/kg以及体重较低与颅内出血显著相关。
颅内出血是急性心肌梗死患者使用tPA时罕见但严重的并发症。适当的药物剂量可降低该并发症的风险。对于有中风病史的急性心肌梗死患者，其他治疗方法，如直接冠状动脉成形术，可能更可取。
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