Early blood pressure lowering in patients with intracerebral haemorrhage and prior use of antithrombotic agents: pooled analysis of the INTERACT studies
Early blood pressure lowering in patients with intracerebral haemorrhage and prior use of antithrombotic agents: pooled analysis of the INTERACT studies
复制标题
DOI：
10.1136/jnnp-2016-313246
复制
发表时间：
2016-12-01
影响因子：
11
通讯作者：
Anderson, Craig S.
中科院分区：
文献类型：
--
作者：
Song, Lili;Sandset, Else Charlotte;Anderson, Craig S.
目的抗血栓药物增加脑出血（ICH）的风险和相关的不良后果。在急性脑出血强化降压试验（INTERACT1和2）中，我们确定了抗血栓相关脑出血患者早期血压（BP）降低的不同效果。设计对INTERACT研究进行事后汇总分析——国际、多中心、前瞻性、开放、盲法终点试验，研究对象为脑出血（< 6小时）和收缩压升高（收缩压150-180毫米汞柱）的患者，随机分配为强化（目标收缩压< 140毫米汞柱）或基于指南的（收缩压< 180毫米汞柱）血压管理。使用logistic回归分析抗血栓使用和(1)死亡或依赖性（修改Rankin量表得分3-6）的关联，(2)在协方差分析中估计血肿增加+脑室内出血（IVH）超过24小时伴有/不伴有脑室内出血（IVH）的情况。结果共纳入3184例患者。抗血栓相关脑出血（364例，11%）与死亡或依赖风险显著增加无关（or 1.38, 95% CI 0.93 - 2.04）。降压治疗对死亡或依赖性的影响不存在异质性。在1309例24小时后随访CT的患者中，与未使用抗栓药物的患者相比，使用抗栓药物的患者血肿+/- IVH体积的绝对增加（5.2/5.0 mL）更大（2.2/0.9 mL; p= 0.022/0.031）。强化降压使使用抗血栓药物的患者血肿+/- IVH生长减少4.7/7.1 mL，而未使用抗血栓药物的患者血肿+/- IVH生长减少1.3/1.4 mL，尽管这些差异没有统计学意义（p齐性= 0.104/0.059）。结论：在脑出血患者中，先前的抗血栓治疗与较大的血肿生长有关，早期强化降压治疗可减少血肿生长。
Objective Antithrombotic agents increase risks of intracerebral haemorrhage (ICH) and associated adverse outcomes. We determined differential effects of early blood pressure (BP) lowering in patients with/without antithrombotic-associated ICH in the Intensive Blood Pressure Reduction in Acute Cerebral Haemorrhage Trials (INTERACT1 and 2).Design Post hoc pooled analyses of the INTERACT studies-international, multicentre, prospective, open, blinded end point trials of patients with ICH (< 6 h) and elevated systolic BP (SBP 150-180 mm Hg) randomly assigned to intensive (target SBP < 140 mm Hg) or guideline-based (SBP < 180 mm Hg) BP management. Associations of antithrombotic use and (1) death or dependency (modified Rankin scale scores 3-6) were analysed using logistic regression, and (2) of increased haematoma+ intraventricular haemorrhage volume (IVH) with/without intraventricular haemorrhage (IVH) over 24 h were estimated in analyses of covariance.Results In all, 3184 patients were included in these analyses. Antithrombotic-associated ICH (364 patients, 11%) was not associated with a significantly increased risk of death or dependency (OR 1.38, 95% CI 0.93 to 2.04). There was no heterogeneity in the BP-lowering treatment effect on death or dependency. Among 1309 patients who underwent follow-up CT after 24 h, absolute increase in haematoma +/- IVH volume was larger (5.2/5.0 mL) in those with compared to those without prior antithrombotics (2.2/0.9 mL; p= 0.022/0.031). Intensive BP lowering reduced haematoma +/- IVH growth by 4.7/7.1 mL in patients on antithrombotics versus 1.3/1.4 mL in those without, although these differences did not reach statistical significance (p homogeneity= 0.104/0.059).Conclusions In patients with ICH, prior antithrombotic therapy is associated with greater haematoma growth, which may be reduced by early intensive BP-lowering treatment.