两种抗血栓方案在颅内破裂动脉瘤支架辅助栓塞术后的疗效对比
A comparison of therapeutic effects of two antithrombotic regimens after stent assisted embolization for intracranial ruptured aneurysms
李钢 1郑鉴峰 1张家淳 1孙晓川1
作者信息
- 1. 重庆医科大学附属第一医院神经外科,重庆 400016
- 折叠
摘要
目的 对比颅内破裂动脉瘤支架辅助介入栓塞手术后采用直接抗血小板治疗与先抗凝治疗再抗血小板治疗的疗效差异.方法 通过回顾性队列研究,分析2019年1月至2021年12月在重庆医科大学附属第一医院接受支架辅助介入栓塞手术的142例颅内破裂动脉瘤患者.根据术后抗血栓方案,抗血小板组37例(26.1%),先抗凝治疗再抗血小板治疗组105例(73.9%).比较两组患者的年龄、性别、糖尿病、高血压、术后出血及缺血并发症、动脉瘤尺寸、动脉瘤数量、动脉瘤位置等差异;所有患者进行临床随访,通过分析术后出血事件、缺血事件的发生例数和评估出院后2-5个月(平均3个月)mRS评分比较两组患者的短期预后来评价不同治疗方案的疗效.结果 抗血小板组患者和先抗凝治疗再抗血小板治疗组的年龄、性别、高血压、糖尿病、动脉瘤数量、动脉瘤尺寸和动脉瘤位置无显著差异(P>0.05).共有29例患者介入术后出现出血并发症,其中全程抗血小板组12例,先抗凝治疗后再改用抗血小板组17例,与抗血小板治疗组的患者相比,先抗凝治疗再抗血小板治疗组的患者出血并发症发生率更低(16.2%vs 32.4%;P<0.05).两组患者的临床预后良好率(81.1%vs 81.0%)、临床预后不良率(18.9%vs 19.0%)、死亡率(5.4%vs 2.9%)差异无统计学意义.结论 与全程抗血小板治疗相比,先抗凝再改用抗血小板治疗可降低颅内破裂动脉瘤患者支架辅助介入栓塞术后出血并发症的发生率.
Abstract
Objective To compare the efficacy of direct antiplatelet therapy and anticoagulation therapy followed by antiplatelet therapy after intracranial aneurysm stent-assisted interventional embolization.Methods A retrospective cohort study was conducted to analyze the 142 patients with ruptured intracranial aneurysms who underwent stent-assisted interventional embolization in the First Affiliated Hospital of Chongqing Medical University from January 2019 to December 2021.According to the postoperative antithrombotic regimen,37 patients(26.1%)were in the antiplatelet group and 105 patients(73.9%)were in the anticoagulant+antiplatelet group.The differences of age,sex,diabetes,hypertension,postoperative bleeding and ischemic complications,aneurysm size,aneurysm number and aneurysm location were compared between these two groups.All patients were followed up clinically.By analyzing the number of postoperative bleeding events and ischemic events and evaluating mRS Scores 2-5 months after discharge(mean:3 months),the short-term pre-evaluation efficacy of different treatment regimens between the two groups was compared.Results There were no significant differences in age,sex,hypertension,diabetes,aneurysm number,aneurysm size and aneurysm location between the two groups(P>0.05).A total of 29 patients experienced bleeding complications after intervention,including 12 cases in the full course antiplatelet group and 17 cases in the anticoagulant first group followed by antiplatelet combined group.Compared with the antiplatelet group,the incidence of bleeding complications in the anticoagulant first group followed by antiplatelet therapy was lower(16.2%vs 32.4%;P<0.05).There was no significant difference in the rate of good clinical prognosis(81.1%vs 81.0%),poor clinical prognosis(18.9%vs 19.0%)and mortality(5.4%vs 2.9%).Conclusions Compared with full course antiplatelet therapy,anticoagulation therapy followed by antiplatelet therapy can reduce the incidence of bleeding complications in patients with intracranial ruptured aneurysms undergoing stent assisted embolization.
关键词
颅内破裂动脉瘤/抗凝治疗/抗血小板治疗/疗效Key words
Ruptured intracranial aneurysms/Anticoagulant therapy/Antiplatelet therapy/Risk factors引用本文复制引用
基金项目
国家自然科学基金面上项目(82071332)
出版年
2024
NETL
NSTL
万方数据