Dual antiplatelet therapy in aneurysmal subarachnoid hemorrhage: association with reduced risk of clinical vasospasm and delayed cerebral ischemia
Dual antiplatelet therapy in aneurysmal subarachnoid hemorrhage: association with reduced risk of clinical vasospasm and delayed cerebral ischemia
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DOI：
10.3171/2017.5.jns17831
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发表时间：
2018-09-01
影响因子：
4.1
通讯作者：
Hasan, David
中科院分区：
文献类型：
--
作者：
Nagahama, Yasunori;Allan, Lauren;Hasan, David
目的脑血管痉挛和迟发性脑缺血是蛛网膜下腔出血（aSAH）的严重并发症.几种涉及血小板活化的理论已被假定为临床血管痉挛和DCI发展的潜在解释。然而，双重抗血小板治疗（DAPT;阿司匹林和氯吡格雷）对临床血管痉挛和DCI的影响尚未研究。本研究的目的是评估DAPT对aSAHpatients.METHODS的临床血管痉挛和DCI的影响，在2009年7月至2014年4月期间接受aSAH治疗的患者进行了分析，在一个单一的机构回顾性研究。患者被分为2组：接受支架辅助弹簧圈栓塞术或放置需要DAPT的血流导向装置的患者（DAPT组）和仅接受弹簧圈栓塞术而不进行DAPT的患者（对照组）。症状性临床血管痉挛和DCI和出血性并发症的频率进行了比较，利用单变量和多变量logistic regression.Results的312 aSAH患者被认为是这项研究，161符合纳入标准，并被纳入分析（85例患者在DAPT组和76例患者在对照组）。在接受DAPT的患者中，临床血管痉挛（OR 0.244，CI 95% 0.097-0.615，p = 0.003）和DCI（OR 0.056，CI 95% 0.01-0.318，p = 0.001）的风险显著降低。两组与放置脑室外引流和脑室腹腔分流相关的出血并发症发生率相似（4% vs 2%，p = 0.9）。结论：在接受aSAH治疗的患者中，使用DAPT与临床血管痉挛和DCI风险降低相关，而出血并发症风险不增加。
OBJECTIVE Clinical vasospasm and delayed cerebral ischemia (DCI) are devastating complications of aneurysmal subarachnoid hemorrhage (aSAH). Several theories involving platelet activation have been postulated as potential explanations of the development of clinical vasospasm and DCI. However, the effects of dual antiplatelet therapy (DAPT; aspirin and clopidogrel) on clinical vasospasm and DCI have not been previously investigated. The objective of this study was to evaluate the effects of DAPT on clinical vasospasm and DCI in aSAH patients.METHODS Analysis of patients treated for aSAH during the period from July 2009 to April 2014 was performed in a single-institution retrospective study. Patients were divided into 2 groups: patients who underwent stent-assisted coiling or placement of flow diverters requiring DAPT (DAPT group) and patients who underwent coiling only without DAPT (control group). The frequency of symptomatic clinical vasospasm and DCI and of hemorrhagic complications was compared between the 2 groups, utilizing univariate and multivariate logistic regression.RESULTS Of 312 aSAH patients considered for this study, 161 met the criteria for inclusion and were included in the analysis (85 patients in the DAPT group and 76 patients in the control group). The risks of clinical vasospasm (OR 0.244, CI 95% 0.097-0.615, p = 0.003) and DCI (OR 0.056, CI 95% 0.01-0.318, p = 0.001) were significantly lower in patients receiving DAPT. The rates of hemorrhagic complications associated with placement of external ventricular drains and ventriculoperitoneal shunts were similar in both groups (4% vs 2%, p = 0.9).CONCLUSIONS The use of DAPT was associated with a lower risk of clinical vasospasm and DCI in patients treated for aSAH, without an increased risk of hemorrhagic complications.