Deep K Pujara, M Shazam Hussain, Michael G Abraham, Santiago Ortega-Gutierrez, Michael Chen, Scott E Kasner, Leonid Churilov, Clark W Sitton, Spiros Blackburn, Sophia Sundararajan, Yin C Hu, Nabeel A Herial, Ronald F Budzik, William J Hicks, Juan F Arenillas, Jenny P Tsai, Osman Kozak, Dennis J Cordato, Nathan W Manning, Ricardo A Hanel, Amin N Aghaebrahim, Teddy Y Wu, Pere Cardona Portela, Natalia Pérez de la Ossa, Joanna D Schaafsma, Jordi Blasco, Navdeep Sangha, Steven Warach, Chirag D Gandhi, Fawaz Al-Mufti, Timothy J Kleinig, Faisal Al-Shaibi, Kelsey R Duncan, Faris Shaker, Hannah Johns, Wei Xiong, Michael DeGeorgia, Amanda Opaskar, Jeffrey Sunshine, Abhishek Ray, Pascal Jabbour, Nicholas Bambakidis, Cathy Sila, Thanh N Nguyen, James C Grotta, Ameer E Hassan, Marc Ribo, Michael D Hill, Bruce C Campbell, Amrou Sarraj
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引用次数: 0
摘要
接受口服抗凝剂(OAC)治疗的大面积核心梗死患者接受血管内血栓切除术(EVT)的安全性和有效性尚不清楚。在 SELECT2 试验(NCT03876457)中,180 例 EVT 患者中有 29 例(16%;维生素 K 拮抗剂 15 例,直接 OAC 14 例)和 172 例药物治疗 (MM) 患者中有 18 例(10%;维生素 K 拮抗剂 3 例,直接 OAC 15 例)报告基线时使用了 OAC。在 OAC 组中,EVT 与更好的临床疗效无关(EVT 6 [4-6] vs MM 5 [4-6],调整后的广义赔率为 0.89 [0.53-1.50]),但在未使用 OAC 的患者中,EVT 的疗效显著更好(EVT 4 [3-6] vs MM 5 [4-6],调整后的广义赔率为 1.87 [1.45-2.40],P = 0.02)。OAC 组合并症较多,包括心房颤动(70% vs 17%)、充血性心力衰竭(28% vs 10%)和高血压(87% vs 72%),这表明虚弱程度增加。然而,在对这些合并症进行调整后,结果是一致的,而且无论使用哪种 OACs,结果都相似。虽然接受EVT治疗的OAC组出血率更高(OAC组为86%,无OAC组为70%),但在EVT组和MM组使用OAC时均未观察到实质出血或症状性颅内出血。虽然我们没有发现证据表明这种效应是由于出血过多或受到潜在心脏病或年龄偏大的影响,但不能仅凭使用 OAC 就将患者排除在 EVT 之外。在做出个体化治疗决定时,应考虑基线合并症和缺血性损伤程度。ann neurol 2024.
Anticoagulation Use and Endovascular Thrombectomy in Patients with Large Core Stroke: A Secondary Analysis of the SELECT2 Trial.
Endovascular thrombectomy (EVT) safety and efficacy in patients with large core infarcts receiving oral anticoagulants (OAC) are unknown. In the SELECT2 trial (NCT03876457), 29 of 180 (16%; vitamin K antagonists 15, direct OACs 14) EVT, and 18 of 172 (10%; vitamin K antagonists 3, direct OACs 15) medical management (MM) patients reported OAC use at baseline. EVT was not associated with better clinical outcomes in the OAC group (EVT 6 [4-6] vs MM 5 [4-6], adjusted generalized odds ratio 0.89 [0.53-1.50]), but demonstrated significantly better outcomes in patients without OAC (EVT 4 [3-6] vs MM 5 [4-6], adjusted generalized odds ratio 1.87 [1.45-2.40], p = 0.02). The OAC group had higher comorbidities, including atrial fibrillation (70% vs 17%), congestive heart failure (28% vs 10%), and hypertension (87% vs 72%), suggesting increased frailty. However, the results were consistent after adjustment for these comorbidities, and was similar regardless of the type of OACs used. Whereas any hemorrhage rates were higher in the OAC group receiving EVT (86% in OAC vs 70% in no OAC), no parenchymal hemorrhage or symptomatic intracranial hemorrhage were observed with OAC use in both the EVT and MM arms. Although we did not find evidence that the effect was due to excess hemorrhage or confounded by underlying cardiac disease or older age, OAC use alone should not exclude patients from receiving EVT. Baseline comorbidities and ischemic injury extent should be considered while making individualized treatment decisions. ANN NEUROL 2024;96:887-894.
期刊介绍:
Annals of Neurology publishes original articles with potential for high impact in understanding the pathogenesis, clinical and laboratory features, diagnosis, treatment, outcomes and science underlying diseases of the human nervous system. Articles should ideally be of broad interest to the academic neurological community rather than solely to subspecialists in a particular field. Studies involving experimental model system, including those in cell and organ cultures and animals, of direct translational relevance to the understanding of neurological disease are also encouraged.