目的:在颅内出血(ICH)患者中,与VKA单药治疗相比,先前同时使用维生素K拮抗剂(VKAs)和抗血小板(AP)治疗可增加血肿体积和死亡率。然而,非维生素K口服拮抗剂(NOACs)和AP的合并使用尚未明确.
方法:我们进行了一项PASTA注册研究,这是一个观察,多中心,在日本注册了1043例接受口服抗凝剂(OAC)的中风患者。在本研究中,来自PASTA注册的ICH用于分析四组之间的临床特征,包括死亡率(NOAC,VKA,NOAC和AP,以及VKA和AP)使用单变量和多变量分析。
结果:在216例ICH患者中,118(54.6%),27(12.5%),55(25.5%),16人(7.4%)正在服用NOAC单药治疗,NOAC和AP,VKA,VKA和AP,分别。VKA和AP(31.3%)的住院死亡率最高,而NOAC(11.9%),NOAC和AP(7.4%),和VKA(7.3%)。多因素logistic回归分析表明,同时使用VKA和AP(比值比[OR],20.57;95%置信区间[CI],1.75-241.75,p=0.0162),最初的美国国立卫生研究院卒中量表评分(OR,1.21;95CI,1.10-1.37,p<0.0001),血肿体积(OR,1.41;95CI,1.10-1.90,p=0.066),和收缩压(OR,1.31;95CI,1.00-1.75,p=0.0422)与住院死亡率独立相关。
结论:尽管VKA加上AP治疗会增加院内死亡率,NOAC和AP没有增加血肿体积,中风严重程度,或死亡率与NOAC单药治疗相比。
Prior concomitant use of vitamin K antagonists (VKAs) and antiplatelet (AP) therapy increase the hematoma volume and mortality compared with VKA monotherapy in patients with intracranial hemorrhage (ICH). However, the prior concomitant use of non-vitamin K oral antagonists (NOACs) and AP has not been clarified.
We conducted a PASTA registry
study, which was an observational, multicenter, registry of 1043 patients with stroke receiving oral anticoagulants (OACs) in Japan. In the present
study, ICH from the PASTA registry was used to analyze the clinical characteristics including mortality among the four groups (NOAC, VKA, NOAC and AP, and VKA and AP) using univariate and multivariate analyses.
Among the 216 patients with ICH, 118 (54.6%), 27 (12.5%), 55 (25.5%), 16 (7.4%) were taking NOAC monotherapy, NOAC and AP, VKA, and VKA and AP, respectively. In-hospital mortality rates were the highest in VKA and AP (31.3%) than in NOACs (11.9%), NOACs and AP (7.4%), and VKA (7.3%). Multivariate logistic regression analysis demonstrated that the concomitant use of VKA and AP (odds ratio [OR], 20.57; 95% confidence interval [CI], 1.75-241.75, p = 0.0162), initial National Institutes of Health Stroke Scale score (OR, 1.21; 95%CI, 1.10-1.37, p < 0.0001), hematoma volume (OR, 1.41; 95%CI, 1.10-1.90, p = 0.066), and systolic blood pressure (OR, 1.31; 95%CI, 1.00-1.75, p = 0.0422) were independently associated with in-hospital mortality.
Although VKA in addition to AP therapy could increase the in-hospital mortality, NOAC and AP did not increase the hematoma volume, stroke severity, or mortality compared to NOAC monotherapy.