Periprocedural Antithrombotic Treatment During Acute Mechanical Thrombectomy for Ischemic Stroke: A Systematic Review.
Periprocedural Antithrombotic Treatment During Acute Mechanical Thrombectomy for Ischemic Stroke: A Systematic Review.
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DOI：
10.3389/fneur.2018.00238
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发表时间：
2018
影响因子：
3.4
通讯作者：
Roozenbeek B
中科院分区：
文献类型：
--
作者：
van de Graaf RA;Chalos V;Del Zoppo GJ;van der Lugt A;Dippel DWJ;Roozenbeek B
超过三分之一的颅内大血管闭塞引起的缺血性卒中患者尽管通过急性机械血栓切除术（MT）快速成功再通，但仍无法恢复功能独立性。这可能部分地由不完全的微血管再灌注解释。一些抗血栓药物，例如，抗血小板剂和肝素，可能能够恢复微血管再灌注。然而，抗血栓药物也可能增加症状性颅内出血（sICH）的风险。本综述旨在评估急性MT治疗缺血性卒中期间围手术期使用抗血小板或肝素的潜在安全性和功能结局。我们系统地检索了PubMed、Embase、Medline、Web of Science和科克伦，寻找研究缺血性中风急性MT期间围手术期抗血小板或肝素治疗的安全性和功能结局的研究。主要结局是sICH的风险。次要结局为3-6个月后的功能独立性（改良兰金量表0-2）和6个月内的死亡率。通过检索识别出837项研究，其中19项研究被纳入。围手术期使用抗血小板药物的sICH风险范围为6%至17%，使用肝素的sICH风险范围为5%至12%。四项研究中有两项报告了使用抗血栓药物的相对影响，指出sICH的风险增加。在接受抗血小板药物治疗的患者中，功能独立性从23%到60%不等，死亡率从18%到33%不等。对于肝素，这分别为19-54%和19- 33%。三项研究显示了抗血小板药物对功能独立性的相对影响，显示了中性影响。两项报告肝素对功能独立性的相对影响的研究发现，肝素增加了这种可能性。缺乏研究MT围手术期抗血栓治疗效果的随机对照试验。一些观察性研究报告sICH风险略有增加，这可能是可接受的，因为它们也表明对功能结局有有益影响。因此，有必要进行随机对照试验，以解决功能结局改善是否超过sICH潜在较高风险的问题。
More than one-third of the patients with ischemic stroke caused by an intracranial large vessel occlusion do not recover to functional independence despite fast and successful recanalization by acute mechanical thrombectomy (MT). This may partially be explained by incomplete microvascular reperfusion. Some antithrombotics, e.g., antiplatelet agents and heparin, may be able to restore microvascular reperfusion. However, antithrombotics may also increase the risk of symptomatic intracranial hemorrhage (sICH). The aim of this review was to assess the potential safety and functional outcome of periprocedural antiplatelet or heparin use during acute MT for ischemic stroke. We systematically searched PubMed, Embase, Medline, Web of Science, and Cochrane for studies investigating the safety and functional outcome of periprocedural antiplatelet or heparin treatment during acute MT for ischemic stroke. The primary outcome was the risk for sICH. Secondary outcomes were functional independence after 3–6 months (modified Rankin Scale 0–2) and mortality within 6 months. 837 studies were identified through the search, of which 19 studies were included. The sICH risks of the periprocedural use of antiplatelets ranged from 6 to 17%, and for heparin from 5 to 12%. Two of four studies reporting relative effects of the use of antithrombotics are pointing toward an increased risk of sICH. Among patients treated with antiplatelet agents, functional independence varied from 23 to 60% and mortality from 18 to 33%. For heparin, this was, respectively, 19–54% and 19–33%. The three studies presenting relative effects of antiplatelets on functional independence showed neutral effects. Both studies reporting relative effects of heparin on functional independence found it to increase this chance. Randomized controlled trials investigating the effect of periprocedural antithrombotic treatment in MT are lacking. Some observational studies report a slight increase in sICH risk, which may be acceptable because they also suggest a beneficial effect on functional outcome. Therefore, randomized controlled trials are warranted to address the question whether the potentially higher risk of sICH could be outweighed by improved functional outcome.
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影响因子：
3.5
作者：
Behme, D.;Mpotsaris, A.;Weber, W.
通讯作者：
Weber, W.
DOI：
10.1016/j.jstrokecerebrovasdis.2015.12.022
发表时间：
2016-05-01
影响因子：
2.5
作者：
Enomoto, Yukiko;Yoshimura, Shinichi;Sakai, Nobuyuki
通讯作者：
Sakai, Nobuyuki
影响因子：
6.3
作者：
EMBER, JA;DELZOPPO, GJ;HUGLI, TE
通讯作者：
HUGLI, TE
影响因子：
158.5
作者：
Hacke, Werner;Kaste, Markku;Toni, Danilo
通讯作者：
Toni, Danilo
影响因子：
2.8
作者：
Ernst, M.;Butscheid, F.;Eckert, B.
通讯作者：
Eckert, B.