使用抗凝剂和抗血小板药物的脑内出血患者的中风严重程度和预后:来自日本中风数据库的分析。

IF 6.3 2区 医学 Q1 CLINICAL NEUROLOGY International Journal of Stroke Pub Date : 2024-10-21 DOI:10.1177/17474930241292022
Yoshito Arakaki, Sohei Yoshimura, Kazunori Toyoda, Kazutaka Sonoda, Shinichi Wada, Michikazu Nakai, Jin Nakahara, Masayuki Shiozawa, Junpei Koge, Akiko Ishigami, Kaori Miwa, Takako Torii-Yoshimura, Junji Miyazaki, Yoshihiro Miyamoto, Kazuo Minematsu, Masatoshi Koga
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引用次数: 0

摘要

背景和目的:一些脑出血患者在发病时服用了抗血栓药物,这些药物可能会恶化预后,但不同口服抗凝剂和抗血小板药物的相对风险尚不确定。我们确定了脑出血患者发病前服用抗血栓药物与最初中风严重程度及预后之间的关系:方法:纳入 2017 年 1 月至 2020 年 12 月间发病后 24 小时内入院的脑出血患者,这些患者被纳入日本卒中数据库(一个基于医院的多中心前瞻性登记系统)。入选患者根据入院时使用的抗血栓药物类型分为四组。结果为入院时美国国立卫生研究院卒中量表(NIHSS)评分和出院时改良Rankin量表(mRS)5-6分:在9810名脑出血患者中(女性4267人,平均年龄(70±15)岁),77.1%的患者属于无抗血栓药物组,13.2%的患者属于抗血小板组,4.0%的患者属于华法林组,5.8%的患者属于直接口服抗凝剂(DOAC)组。四组患者入院时的 NIHSS 评分中位数(四分位数间距)分别为 12(5-22)、13(5-26)、15(5-30)和 13(6-24)。在多变量分析中,卒中前使用华法林与较高的 NIHSS 评分相关(调整后发病率比为 1.09 [95%置信区间 (CI),1.06-1.13],以无抗血栓组为参照),但抗血小板组(1.00 [95%CI,0.98-1.02])和 DOAC 组(0.98 [95%CI,0.95-1.01])则不相关。四组患者出院时 mRS 5-6 的比例分别为 30.8%、41.9%、48.6% 和 41.5%。在多变量分析中,卒中前服用华法林与 mRS 5-6 相关(调整后的比值比:1.90 [95%CI,1.28-2.81],以无抗血栓组为参照),但抗血小板组(1.12 [95%CI,0.91-1.37])和 DOAC 组(1.25 [95%CI,0.88-1.77])与之无关:结论:脑出血发病前服用华法林的患者脑出血更严重,表现为入院时NIHSS更高,出院时mRS更高。相比之下,服用抗血小板药物的患者病情严重程度没有增加。
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Stroke severity and outcomes in patients with intracerebral hemorrhage on anticoagulants and antiplatelet agents: An analysis from the Japan Stroke Data Bank.

Background and aim: Some patients with intracerebral hemorrhage are on antithrombotic agents at the time of the event and these may worsen outcome, but the relative risk of different oral anticoagulants and antiplatelet agents is uncertain. We determined associations between pre-onset intake of antithrombotic agents and initial stroke severity, and outcomes, in patients with intracerebral hemorrhage.

Methods: Patients with intracerebral hemorrhage admitted within 24 h after onset between January 2017 and December 2020 and recruited to the Japan Stroke Data Bank, a hospital-based multicenter prospective registry, were included. Enrolled patients were classified into four groups based on the type of antithrombotic agents being used on admission. The outcomes were the National Institutes of Health Stroke Scale (NIHSS) score on admission and modified Rankin Scale (mRS) of 5-6 at discharge.

Results: Of a total 9810 patients with intracerebral hemorrhage (4267 females; mean age = 70 ± 15 years), 77.1% were classified into the no-antithrombotic group, 13.2% into the antiplatelet group, 4.0% into the warfarin group, and 5.8% into the direct oral anticoagulant (DOAC) group. Median (interquartile range) NIHSS score on admission was 12 (5-22), 13 (5-26), 15 (5-30), and 13 (6-24), respectively, in the four groups. In multivariable analysis, the prestroke warfarin use was associated with higher NIHSS score (adjusted incidence rate ratio = 1.09 (95% confidence interval (CI) = 1.06-1.13), with the no-antithrombotic group as the reference), but the antiplatelet group (1.00 (95% CI = 0.98-1.02)) and DOAC group (0.98 (95% CI = 0.95-1.01)) were not. The rate of mRS 5-6 at discharge was 30.8%, 41.9%, 48.6%, and 41.5%, respectively, in the four groups. In multivariable analysis, prestroke warfarin use was associated with mRS 5-6 (adjusted odds ratio = 1.90 (95% CI = 1.28-2.81), with the no-antithrombotic group as the reference), but the antiplatelet group (1.12 (95% CI = 0.91-1.37)) and DOAC group (1.25 (95% CI = 0.88-1.77)) were not.

Conclusion: Patients who were taking warfarin prior to intracerebral hemorrhage onset suffered more severe intracerebral hemorrhage as evidenced by higher admission NIHSS and higher discharge mRS. In contrast, no increase in severity was seen with antiplatelet agents.

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来源期刊
International Journal of Stroke
International Journal of Stroke 医学-外周血管病
CiteScore
13.90
自引率
6.00%
发文量
132
审稿时长
6-12 weeks
期刊介绍: The International Journal of Stroke is a welcome addition to the international stroke journal landscape in that it concentrates on the clinical aspects of stroke with basic science contributions in areas of clinical interest. Reviews of current topics are broadly based to encompass not only recent advances of global interest but also those which may be more important in certain regions and the journal regularly features items of news interest from all parts of the world. To facilitate the international nature of the journal, our Associate Editors from Europe, Asia, North America and South America coordinate segments of the journal.
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