Safety and efficacy of early antiplatelet therapy in acute ischemic stroke patients receiving endovascular treatment: A systematic review and meta-analysis
Safety and efficacy of early antiplatelet therapy in acute ischemic stroke patients receiving endovascular treatment: A systematic review and meta-analysis
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接受血管内治疗的急性缺血性脑卒中患者早期抗血小板治疗的安全性和有效性：系统评价和荟萃分析
DOI：
10.1016/j.jocn.2019.05.028
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发表时间：
2019-05
影响因子：
2
通讯作者：
Jie Yang
中科院分区：
文献类型：
--
作者：
Yijia Guo;Yapeng Lin;Yifang Tang;Qin Tang;Xiaoqing Wang;Xiding Pan;JianJun Zou;Jie Yang
背景血管内治疗（Endovasculartreatment，ET）已被证实是治疗急性缺血性脑卒中安全、有效的方法.然而，早期再闭塞是ET后不可避免的并发症。早期抗血小板治疗对接受血管内治疗的急性缺血性卒中患者结局的影响存在不确定性。安全性结局为任何颅内出血（ICH）、症状性颅内出血（sICH）和死亡率。疗效结局为再通率和随访功能结局。Review Manager 5.3和Stata Software Package 14.0被用来进行Meta-analysis.ResultsSeven研究，共1251例患者被纳入。451例（36.1%）患者在ET后使用抗血小板药物。荟萃分析表明，早期抗血小板治疗不会增加ICH（OR 1.15; 95% CI 0.56-2.37; P = 0.70）、sICH（OR 1.29; 95% CI 0.79-2.09; P = 0.31）和死亡率（OR 0.71; 95% CI 0.45-1.12; P = 0.14）的风险。抗血小板治疗与再通率（OR 1.03; 95% CI 0.73-1.46; P = 0.30）或功能结局（OR 0.97; 95% CI 0.55-1.69; P = 0.90）之间无相关性。敏感性分析显示替罗非班与ET或机械取栓术患者的颅内出血和死亡率无相关性，也未改善再通率和功能结局（均P > 0.05）。结论早期抗血小板治疗急性缺血性脑卒中可能是安全的，疗效有待进一步研究证实。
BackgroundEndovascular treatment (ET) has been proved as safety and effective in acute ischemic stroke. However, early reocclusion is an inevitable complication following ET. There is uncertainty effect of early antiplatelet therapy on outcomes in patients with acute ischemic stroke undergoing endovascular treatment.MethodsWe searched major databases for articles published from 2011 to 2019 in the present study. Safety outcomes were any intracranial hemorrhage (ICH), symptomatic intracranial hemorrhage (sICH) and mortality. Efficacy outcomes were recanalization rate and follow-up functional outcome. Review Manager 5.3 and Stata Software Package 14.0 were used to perform the meta-analysis.ResultsSeven studies with a total of 1251 patients were included. A total of 451 (36.1%) patients were administrated by antiplatelet agent following ET. Meta-analysis suggested that early antiplatelet did not increase the risk for ICH (OR 1.15; 95% CI 0.56–2.37; P = 0.70), sICH (OR 1.29; 95% CI 0.79–2.09; P = 0.31) and mortality (OR 0.71; 95% CI 0.45–1.12; P = 0.14). There was no association between antiplatelet therapy and recanalization rate (OR 1.03; 95% CI 0.73–1.46; P = 0.30) or functional outcome (OR 0.97; 95% CI 0.55–1.69; P = 0.90). Sensitivity analysis indicated tirofiban did not associated with any ICH and mortality, nor improve the recanalization rate and functional outcome in patients receiving ET or mechanical thrombectomy (all p > 0.05).ConclusionsEarly antiplatelet therapy may be safe in acute ischemic stroke patients, further studies are needed to confirm the efficacy.
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DOI：
10.1016/s0749-4041(08)79111-5
发表时间：
2009
期刊：
Yearbook of Vascular Surgery
影响因子：
--
作者：
G. Moneta
通讯作者：
G. Moneta
DOI：
10.1136/bmj.b2535
发表时间：
2009-07-21
期刊：
BMJ (Clinical research ed.)
影响因子：
--
作者：
Moher D;Liberati A;Tetzlaff J;Altman DG;PRISMA Group
通讯作者：
PRISMA Group
影响因子：
3.7
作者：
Lee JI;Gliem M;Gerdes G;Turowski B;Kaschner M;Kraus B;Hartung HP;Jander S
通讯作者：
Jander S
DOI：
10.1016/s0513-5117(09)79035-0
发表时间：
2009
期刊：
Yearbook of Neurology and Neurosurgery
影响因子：
--
作者：
A. Rabinstein
通讯作者：
A. Rabinstein
影响因子：
1.5
作者：
Monique Lloyd
通讯作者：
Monique Lloyd