Nikolaos S Avramiotis, Fabian Schaub, Sebastian Thilemann, Philippe Lyrer, Stefan T Engelter
{"title":"治疗颈动脉夹层的抗血栓药物：最新系统综述。","authors":"Nikolaos S Avramiotis, Fabian Schaub, Sebastian Thilemann, Philippe Lyrer, Stefan T Engelter","doi":"10.1177/23969873241292278","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>Extracranial internal carotid artery dissection (eICAD) is a leading cause of stroke in younger patients. In this Cochrane Review update we compared benefits and harms of eICAD-patients treated with either antiplatelets or anticoagulants.</p><p><strong>Patients and methods: </strong>Eligible studies were identified through Cochrane Stroke Group Trials Register, CENTRAL, MEDLINE, and EMBASE and personal search until December 2023. We included randomized-controlled trials (RCTs) and non-randomized studies comparing anticoagulants with antiplatelets in eICAD-patients. Co-primary outcomes were (i) death (all causes) and (ii) death or disability. Secondary outcomes were ischemic stroke, symptomatic intracranial hemorrhage, and major extracranial hemorrhage. Odds ratios (OR) with 95% CIs were calculated for (i) all studies and (ii) separately for RCTs and non-randomized studies.</p><p><strong>Results: </strong>We meta-analyzed a total of 42 studies (2624 patients) including 2 RCTs (213 patients) for the primary outcome of death and 31 studies (1953 patients) including 1 RCT (115 patients) for the primary outcome of death or disability. Antiplatelet-treated patients had higher odds for death (OR<sub>all-studies</sub> 2.70, 95% CI 1.27-5.72; OR<sub>RTCs</sub> 6.80, 95% CI 0.14-345; OR<sub>non-randomized studies</sub> 2.60, 95% CI 1.20-5.60) and death or disability (OR<sub>all-studies</sub> 2.1, 95% CI 1.58-2.66; OR<sub>RTCs</sub> 2.2, 95% CI 0.29-16.05; OR<sub>non-randomized studies</sub> 2.1, 95% CI 1.58-2.66) than anticoagulated patients. Antiplatelet-treated patients had also higher odds for ischemic stroke, though this reached statistical significance only in the subgroup of RCTs (OR<sub>RTC</sub> 4.60, 95% CI 1.36-15.51). In turn, antiplatelet-treated patients had less symptomatic intracranial hemorrhage (OR<sub>all-studies</sub> 0.25, 95% CI 0.07-0.86) and a tendency toward less major extracranial hemorrhage (OR<sub>all-studies</sub> 0.17, 95% CI 0.03-1.03).</p><p><strong>Discussion and conclusion: </strong>The evidence considering antiplatelets as standard of care in eICAD is weak. Individualized treatment decisions balancing risks versus harms seem recommendable.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":null,"pages":null},"PeriodicalIF":5.8000,"publicationDate":"2024-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Antithrombotic drugs for carotid artery dissection: Updated systematic review.\",\"authors\":\"Nikolaos S Avramiotis, Fabian Schaub, Sebastian Thilemann, Philippe Lyrer, Stefan T Engelter\",\"doi\":\"10.1177/23969873241292278\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>Extracranial internal carotid artery dissection (eICAD) is a leading cause of stroke in younger patients. In this Cochrane Review update we compared benefits and harms of eICAD-patients treated with either antiplatelets or anticoagulants.</p><p><strong>Patients and methods: </strong>Eligible studies were identified through Cochrane Stroke Group Trials Register, CENTRAL, MEDLINE, and EMBASE and personal search until December 2023. We included randomized-controlled trials (RCTs) and non-randomized studies comparing anticoagulants with antiplatelets in eICAD-patients. Co-primary outcomes were (i) death (all causes) and (ii) death or disability. Secondary outcomes were ischemic stroke, symptomatic intracranial hemorrhage, and major extracranial hemorrhage. Odds ratios (OR) with 95% CIs were calculated for (i) all studies and (ii) separately for RCTs and non-randomized studies.</p><p><strong>Results: </strong>We meta-analyzed a total of 42 studies (2624 patients) including 2 RCTs (213 patients) for the primary outcome of death and 31 studies (1953 patients) including 1 RCT (115 patients) for the primary outcome of death or disability. Antiplatelet-treated patients had higher odds for death (OR<sub>all-studies</sub> 2.70, 95% CI 1.27-5.72; OR<sub>RTCs</sub> 6.80, 95% CI 0.14-345; OR<sub>non-randomized studies</sub> 2.60, 95% CI 1.20-5.60) and death or disability (OR<sub>all-studies</sub> 2.1, 95% CI 1.58-2.66; OR<sub>RTCs</sub> 2.2, 95% CI 0.29-16.05; OR<sub>non-randomized studies</sub> 2.1, 95% CI 1.58-2.66) than anticoagulated patients. Antiplatelet-treated patients had also higher odds for ischemic stroke, though this reached statistical significance only in the subgroup of RCTs (OR<sub>RTC</sub> 4.60, 95% CI 1.36-15.51). In turn, antiplatelet-treated patients had less symptomatic intracranial hemorrhage (OR<sub>all-studies</sub> 0.25, 95% CI 0.07-0.86) and a tendency toward less major extracranial hemorrhage (OR<sub>all-studies</sub> 0.17, 95% CI 0.03-1.03).</p><p><strong>Discussion and conclusion: </strong>The evidence considering antiplatelets as standard of care in eICAD is weak. Individualized treatment decisions balancing risks versus harms seem recommendable.</p>\",\"PeriodicalId\":46821,\"journal\":{\"name\":\"European Stroke Journal\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":5.8000,\"publicationDate\":\"2024-10-26\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"European Stroke Journal\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1177/23969873241292278\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"European Stroke Journal","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1177/23969873241292278","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0
摘要
简介：颅外颈内动脉夹层（eICAD）是年轻患者中风的主要原因：颅外颈内动脉夹层（eICAD）是年轻患者中风的主要原因。在本 Cochrane 综述更新中，我们比较了 eICAD 患者接受抗血小板或抗凝剂治疗的益处和危害：通过 Cochrane Stroke Group Trials Register、CENTRAL、MEDLINE 和 EMBASE 以及截至 2023 年 12 月的个人检索确定了符合条件的研究。我们纳入了随机对照试验（RCT）和非随机研究，这些研究比较了抗凝药物和抗血小板药物在 eICAD 患者中的应用。共同主要结局为：(i) 死亡（所有原因）；(ii) 死亡或残疾。次要结局为缺血性中风、症状性颅内出血和颅外大出血。计算了(i)所有研究和(ii)随机对照研究与非随机对照研究的患病率比（OR）及 95% CI：我们对包括 2 项研究（213 名患者）在内的 42 项研究（2624 名患者）的主要死亡结果进行了荟萃分析，对包括 1 项研究（115 名患者）在内的 31 项研究（1953 名患者）的主要死亡或残疾结果进行了荟萃分析。抗血小板治疗患者的死亡几率更高（所有研究的 OR 为 2.70，95% CI 为 1.27-5.72；ORRTCs 为 6.80，95% CI 为 0.14-345；非随机研究的 OR 为 2.60，95% CI 为 1.20-5.60），死亡或残疾的几率也更高（所有研究的 OR 为 2.70，95% CI 为 1.27-5.72；ORRTCs 为 6.80，95% CI 为 0.14-345；非随机研究的 OR 为 2.60，95% CI 为 1.20-5.6060）和死亡或残疾（ORall-studies 2.1，95% CI 1.58-2.66；ORRTCs 2.2，95% CI 0.29-16.05；ORnon-randomized studies 2.1，95% CI 1.58-2.66）。抗血小板治疗的患者发生缺血性中风的几率也较高，但只有在 RCTs 亚组中才有统计学意义（ORRTC 4.60，95% CI 1.36-15.51）。反过来，抗血小板治疗的患者症状性颅内出血较少（ORall-studies 0.25，95% CI 0.07-0.86），颅外大出血也有减少的趋势（ORall-studies 0.17，95% CI 0.03-1.03）：将抗血小板作为eICAD标准治疗的证据不足。平衡风险与危害的个体化治疗决策似乎值得推荐。
Antithrombotic drugs for carotid artery dissection: Updated systematic review.
Introduction: Extracranial internal carotid artery dissection (eICAD) is a leading cause of stroke in younger patients. In this Cochrane Review update we compared benefits and harms of eICAD-patients treated with either antiplatelets or anticoagulants.
Patients and methods: Eligible studies were identified through Cochrane Stroke Group Trials Register, CENTRAL, MEDLINE, and EMBASE and personal search until December 2023. We included randomized-controlled trials (RCTs) and non-randomized studies comparing anticoagulants with antiplatelets in eICAD-patients. Co-primary outcomes were (i) death (all causes) and (ii) death or disability. Secondary outcomes were ischemic stroke, symptomatic intracranial hemorrhage, and major extracranial hemorrhage. Odds ratios (OR) with 95% CIs were calculated for (i) all studies and (ii) separately for RCTs and non-randomized studies.
Results: We meta-analyzed a total of 42 studies (2624 patients) including 2 RCTs (213 patients) for the primary outcome of death and 31 studies (1953 patients) including 1 RCT (115 patients) for the primary outcome of death or disability. Antiplatelet-treated patients had higher odds for death (ORall-studies 2.70, 95% CI 1.27-5.72; ORRTCs 6.80, 95% CI 0.14-345; ORnon-randomized studies 2.60, 95% CI 1.20-5.60) and death or disability (ORall-studies 2.1, 95% CI 1.58-2.66; ORRTCs 2.2, 95% CI 0.29-16.05; ORnon-randomized studies 2.1, 95% CI 1.58-2.66) than anticoagulated patients. Antiplatelet-treated patients had also higher odds for ischemic stroke, though this reached statistical significance only in the subgroup of RCTs (ORRTC 4.60, 95% CI 1.36-15.51). In turn, antiplatelet-treated patients had less symptomatic intracranial hemorrhage (ORall-studies 0.25, 95% CI 0.07-0.86) and a tendency toward less major extracranial hemorrhage (ORall-studies 0.17, 95% CI 0.03-1.03).
Discussion and conclusion: The evidence considering antiplatelets as standard of care in eICAD is weak. Individualized treatment decisions balancing risks versus harms seem recommendable.
期刊介绍：
Launched in 2016 the European Stroke Journal (ESJ) is the official journal of the European Stroke Organisation (ESO), a professional non-profit organization with over 1,400 individual members, and affiliations to numerous related national and international societies. ESJ covers clinical stroke research from all fields, including clinical trials, epidemiology, primary and secondary prevention, diagnosis, acute and post-acute management, guidelines, translation of experimental findings into clinical practice, rehabilitation, organisation of stroke care, and societal impact. It is open to authors from all relevant medical and health professions. Article types include review articles, original research, protocols, guidelines, editorials and letters to the Editor. Through ESJ, authors and researchers have gained a new platform for the rapid and professional publication of peer reviewed scientific material of the highest standards; publication in ESJ is highly competitive. The journal and its editorial team has developed excellent cooperation with sister organisations such as the World Stroke Organisation and the International Journal of Stroke, and the American Heart Organization/American Stroke Association and the journal Stroke. ESJ is fully peer-reviewed and is a member of the Committee on Publication Ethics (COPE). Issues are published 4 times a year (March, June, September and December) and articles are published OnlineFirst prior to issue publication.
京公网安备 11010802042870号
京ICP备2023020795号-1
分享
求助内容：
应助结果提醒方式：
扫码关注我们
