Safety and efficacy of low-dose aspirin in ischemic stroke patients with different G6PD conditions
Safety and efficacy of low-dose aspirin in ischemic stroke patients with different G6PD conditions
复制标题
小剂量阿司匹林治疗不同 G6PD 状况的缺血性脑卒中患者的安全性和有效性
DOI：
10.1177/1747493020950903
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发表时间：
2020-09-02
影响因子：
6.7
通讯作者：
Zeng, Jinsheng
中科院分区：
文献类型：
--
作者：
Chen, Yicong;Li, Jianle;Zeng, Jinsheng
背景与目的阿司匹林是预防继发性卒中的首选抗血小板药物，但其对伴有葡萄糖-6-磷酸脱氢酶缺乏症的卒中患者的安全性和有效性尚不清楚。我们试图评估其在伴有和不伴有葡萄糖-6-磷酸脱氢酶缺乏症的缺血性中风患者中的安全性和有效性。方法对接受阿司匹林(10 0 mg/d)治疗3个月的缺血性卒中患者进行多中心前瞻性队列研究。卒中后检测血糖-6-磷酸脱氢酶活性。三个月后评估安全性结果，包括急性溶血、中到重度出血和死亡(血管、全因)，以及显示为中风复发的疗效结果。采用多因素分析或COX回归分析确定与中、重度出血和全因死亡相关的危险因素。结果1121例患者中，130例葡萄糖-6-磷酸脱氢酶缺陷患者中81例服用阿司匹林，991例葡萄糖-6-磷酸脱氢酶正常患者中576例服用阿司匹林，疗程3个月。在1例葡萄糖-6-磷酸脱氢酶缺陷患者中观察到急性溶血，在葡萄糖-6-磷酸脱氢酶正常的患者中没有观察到急性溶血(p = 0.876)。葡萄糖-6-磷酸脱氢酶缺陷者和葡萄糖-6-磷酸脱氢酶正常者中、重度出血率分别为2.5%和0.3%(p = 0.045)，全死因死亡率分别为6.2%和1.4%(p = 0.008)。两组中风复发率相似(2.5%vs.1.7%；p = 0.608)。葡萄糖-6-磷酸脱氢酶缺乏与中到重度出血(调整p = 0.048)和使用阿司匹林期间全因死亡(调整p = 0.008)的风险增加显著相关。结论长期小剂量阿司匹林治疗葡萄糖-6-磷酸脱氢酶缺乏症患者的安全性较差，需要进行大量临床试验以进一步证实这一结果。
Background and purpose Aspirin is the first recommended antiplatelet agent to prevention secondary stroke, but its safety and efficacy in stroke patients with glucose-6-phosphate dehydrogenase deficiency remain unclear. We sought to evaluate its safety and efficacy in ischemic stroke patients with and without glucose-6-phosphate dehydrogenase deficiency. Methods Patients with ischemic stroke receiving aspirin (100 mg/day) for three months were recruited for a multicenter, prospective, cohort study. Blood glucose-6-phosphate dehydrogenase activity was examined after stroke. Safety outcomes including acute hemolysis, moderate-to-severe bleeding, and death (vascular, all-cause), and efficacy outcome indicated as stroke recurrence were evaluated at three months. Risk factors associated with moderate-to-severe bleeding and all-cause death were determined using multivariate or Cox regression analysis. Results Among the included 1121 patients, 81 of 130 glucose-6-phosphate dehydrogenase deficient and 576 of 991 glucose-6-phosphate dehydrogenase normal patients received aspirin for three months. Acute hemolysis was observed in one of the glucose-6-phosphate dehydrogenase deficient and in none of the glucose-6-phosphate dehydrogenase normal patients (p = 0.876). The rates of moderate-to-severe bleeding were 2.5% and 0.3% (p = 0.045), and the percentages of all-cause death were 6.2% and 1.4% (p = 0.008) in the glucose-6-phosphate dehydrogenase deficient and glucose-6-phosphate dehydrogenase normal patients. Stroke recurrence rate was similar in the two groups (2.5% vs. 1.7%; p = 0.608). Glucose-6-phosphate dehydrogenase deficiency was significantly associated with increased risk of moderate-to-severe bleeding (adjust p = 0.048) and all-cause death during aspirin use (adjust p = 0.008). Conclusions Long-term low-dose aspirin therapy might relate to worse safety outcomes in patients with glucose-6-phosphate dehydrogenase deficiency and large clinical trials are needed to further confirm these findings.