Antiplatelet therapy and future intracerebral hemorrhage in hemodialysis patients with cerebral microbleeds
Antiplatelet therapy and future intracerebral hemorrhage in hemodialysis patients with cerebral microbleeds
复制标题
血液透析脑微出血患者的抗血小板治疗与未来脑出血的发生
DOI：
10.1016/j.jocn.2021.05.068
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发表时间：
2021
影响因子：
2
通讯作者：
Shintani Ayumi
中科院分区：
文献类型：
--
作者：
Naganuma Toshihide;Kabata Daijiro;Takemoto Yoshiaki;Uchida Junji;Shintani Ayumi
抗血小板药物的使用被认为会增加脑微出血（CMBs）患者脑出血（ICH）的风险。然而，血液透析（HD）患者的CMBs患病率高，病理多样，需要抗血小板治疗。在这项研究中，我们调查了抗血小板药物的使用是否会增加合并CMBs的HD患者发生脑出血的风险。对179例无脑血管事件史的HD患者进行脑磁共振成像（MRI）检查，包括T2*加权MRI。检测CMBs并对患者进行前瞻性随访，中位随访时间为5.2[1.4-6.2]年。为了研究抗血小板治疗对脑出血发展的影响在有和没有CMBs的情况下是否不同，我们使用了治疗加权逆概率法，包括CMBs存在或不存在与抗血小板药物使用之间的相互作用项。结果，45例（25.1%）患者检出CMBs， 66例（36.9%）患者使用抗血小板药物。当基线时CMBs的存在改变了抗血小板治疗对脑出血发生率的影响（相互作用P <0.001）时，抗血小板药物的使用是无CMBs的HD患者脑出血的重要危险因素，而不是伴有CMBs的HD患者。此外，CMBs的负担显著增加了脑出血的风险，但与非抗血小板药物使用者相比，抗血小板药物使用者的这种风险增加较慢（相互作用P = 0.02）。抗血小板药物对脑出血发展的影响取决于是否存在CMBs。事实上，抗血小板药物的使用并没有增加合并CMBs的HD患者发生脑出血的风险。
The use of antiplatelet drugs is thought to increase the risk for intracerebral hemorrhage (ICH) in patients with cerebral microbleeds (CMBs). However, hemodialysis (HD) patients have a high prevalence of CMBs and diverse pathologies that require antiplatelet therapy. In this study, we investigated whether the use of antiplatelet drugs increases the risk for ICH in HD patients with CMBs. Brain magnetic resonance imaging (MRI), including T2*-weighted MRI, was performed in 179 HD patients with no history of cerebrovascular events. CMBs were detected and patients were followed prospectively with a median follow-up period of 5.2 [1.4–6.2] years. To investigate whether the influence of antiplatelet therapy on the development of ICH differs in cases with and without CMBs, the inverse probability of treatment weighting method was used, including an interaction term between the presence or absence of CMBs and use of antiplatelet drugs. As a result, CMBs were detected in 45 patients (25.1%), and antiplatelet drugs were used in 66 patients (36.9%). When the effect of antiplatelet therapy on the incidence of ICH was modified by the presence of CMBs at baseline (P for interaction <0.001), the use of antiplatelet drugs was a significant risk factor for ICH in HD patients without CMBs, but not in HD patients with CMBs. Furthermore, the burden of CMBs significantly increased the risk for ICH, but the increase in this risk was slower in antiplatelet drug users as compared to non-antiplatelet drug users (P for interaction = 0.02). The influence of antiplatelet drugs on the development of ICH differed depending on the presence or absence of CMBs. In fact, the use of antiplatelet drugs did not increase the risk for ICH in HD patients with CMBs.
DOI：
10.1016/j.jstrokecerebrovasdis.2012.08.003
发表时间：
2013-08-01
影响因子：
2.5
作者：
Imaizumi, Toshio;Inamura, Shigeru;Komatsu, Katsuya
通讯作者：
Komatsu, Katsuya
影响因子：
3.2
作者：
Umemura, Toshitaka;Kawamura, Takahiko;Sobue, Gen
通讯作者：
Sobue, Gen
影响因子：
2.1
作者：
Xu, Mangmang;Zhang, Shihong;Liu, Ming
通讯作者：
Liu, Ming