Association between aspirin-induced hemoglobin decline and outcome after acute ischemic stroke in G6PD-deficient patients.
Association between aspirin-induced hemoglobin decline and outcome after acute ischemic stroke in G6PD-deficient patients.
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DOI：
10.1111/cns.13711
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发表时间：
2021-10
影响因子：
5.5
通讯作者：
Zeng J
中科院分区：
文献类型：
--
作者：
Chen Y;Li J;Ou Z;Zhang Y;Liang Z;Deng W;Huang W;Ouyang F;Yu J;Xing S;Zeng J
小剂量阿司匹林在葡萄糖-6-磷酸脱氢酶(G6PD)缺乏症中引起血红蛋白下降的风险仍不清楚，其对中风预后的影响仍有待调查。本研究旨在评价G6PD缺乏对阿司匹林治疗期间血红蛋白水平的影响及其与急性缺血性卒中预后的关系。从一项队列研究中，总共检查了279名急性缺血性中风患者(40名G6PD缺陷患者和239名G6PD正常患者)，每天服用100 mg阿司匹林。主要的安全终点是在阿司匹林治疗后14天内，血红蛋白≥下降25微克/L或较基线下降25%。不良结果定义为3个月时改良的兰金量表评分≥2。χ2检验用于比较卒中结果，多因素Logistic回归分析分析血红蛋白水平和预后之间的关系。G6PD缺陷组的基线血红蛋白水平较低，并倾向于更频繁地发生肺部感染(P<0.05)。服用阿司匹林后，≥下降25微克/L或较基线下降25%(15.0%比3.3%；P=0.006)和贫血(30.0%比14.6%；P=0.016)的患者比例较高，并伴有更显著的胆红素升高。急性缺血性卒中后3个月功能预后不良的发生率在G6PD缺陷组较高(风险比=11.31[95%可信区间(CI)=1.10~1.56]；P=0.017)。混杂因素调整分析显示，较低的血红蛋白水平(优势比=0.98[95%CI=0.96-0.99]；调整后的P=0.009)增加了功能预后不良的风险。G6PD缺乏症患者服用阿司匹林后，血红蛋白降低，胆红素升高，提示有溶血现象，可能影响卒中预后。服用阿司匹林的G6PD缺乏的缺血性卒中患者应仔细监测血红蛋白下降的风险。G6PD缺乏症患者服用阿司匹林后，血红蛋白降低，胆红素升高，提示有溶血现象，可能影响卒中预后。服用阿司匹林的G6PD缺陷型中风患者应仔细监测血红蛋白下降的风险。
The risk of hemoglobin decline induced by low‐dose aspirin in glucose‐6‐phosphate dehydrogenase (G6PD) deficiency remains unknown, and its influence on stroke outcome remains to be investigated. This study aimed to evaluate the effect of G6PD deficiency on hemoglobin level during aspirin treatment and its association with outcome after acute ischemic stroke. In total, 279 patients (40 G6PD‐deficient and 239 G6PD‐normal) with acute ischemic stroke treated with aspirin 100 mg/day from a cohort study were examined. The primary safety endpoint was a hemoglobin decline ≥25 g/L or 25% from baseline within 14 days after aspirin treatment. Poor outcomes were defined as a modified Rankin Scale score ≥2 at 3 months. The χ 2 test was used to compare stroke outcomes, and multivariate logistic regression analyses were performed to analyze the association between hemoglobin level and outcomes. The G6PD‐deficient group had lower baseline hemoglobin and tended to develop comorbid pulmonary infection more frequently (p < 0.05). The proportion of patients with hemoglobin decline ≥25 g/L or 25% from baseline (15.0% vs. 3.3%; p = 0.006) and anemia (30.0% vs. 14.6%; p = 0.016) after aspirin treatment was higher in the G6PD‐deficient group, which was accompanied by a more significant bilirubin increase. The rate of poor functional outcomes at 3 months after acute ischemic stroke was higher in the G6PD‐deficient group (Risk ratio = 1.31 [95% confidence interval (CI) = 1.10–1.56]; p = 0.017). Confounder‐adjusted analysis showed that lower hemoglobin levels (odds ratio = 0.98 [95% CI = 0.96–0.99]; adjusted p = 0.009) increased the risk of poor functional outcomes. Hemoglobin decrease with bilirubin increase after aspirin treatment in patients with G6PD deficiency suggests hemolysis, which may influence stroke prognosis. The risk of hemoglobin decline should be carefully monitored in G6PD‐deficient patients with ischemic stroke taking aspirin. Hemoglobin decrease with bilirubin increase after aspirin treatment in patients with G6PD deficiency suggests hemolysis, which may influence stroke prognosis. The risk of hemoglobin decline should be carefully monitored in G6PD‐deficient stroke patients taking aspirin.
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影响因子：
5.1
作者：
GLADER, BE
通讯作者：
GLADER, BE
影响因子：
2
作者：
Kafkas, N. V.;Liakos, C. I.;Mouzarou, G.
通讯作者：
Mouzarou, G.
影响因子：
5.1
作者：
Kellert, L.;Kloss, M.;Grond-Ginsbach, C.
通讯作者：
Grond-Ginsbach, C.
影响因子：
8.3
作者：
Di Napoli, M;Papa, F;Bocola, V
通讯作者：
Bocola, V
影响因子：
8.3
作者：
Chang, Jun Young;Lee, Ji Sung;Han, Moon-Ku
通讯作者：
Han, Moon-Ku