急性缺血性卒中阿替普酶静脉溶栓后早期抗栓治疗安全性和有效性的荟萃分析

doi:10.3969/j.issn.1673-5765.2018.05.005

摘要/Abstract

摘要：

目的探索急性缺血性卒中患者接受阿替普酶静脉溶栓后24 h内给予抗栓治疗的安全性和有效性。方法利用计算机检索PubMed、Cochrane Library、EMbase和Web of Science数据库，查找关于阿替普酶静脉溶栓后早期抗栓（24 h内）与标准抗栓（24 h后）治疗急性缺血性卒中疗效对比的随机对照试验、匹配对照和非随机对照研究，检索时限均为从建库至2017年10月。由2位评价者按照纳入与排除标准独立筛选文献、提取资料后，采用Stata 14.0软件进行荟萃分析，从而比较溶栓后早期抗栓与标准抗栓治疗发生症状性脑出血、90 d死亡和良好预后差异。结果最终纳入11项研究（包括4项随机对照试验、2项匹配对照和5项非随机对照研究），共计2082 例患者，早期抗栓组有1219例（58.5%），标准抗栓组有863例（41.5%）。荟萃分析结果显示：与标准抗栓组相比，接受早期抗栓的患者90 d良好预后的比例更高[比值比（odds ratio，OR）1.41，95%可信区间（confidence interval，CI）1.15～1.73，P =0.001）]，而两组患者的症状性脑出血发生率（OR 1.08， 95%CI 0.63～1.86，P =0.78）和90 d死亡率（OR 1.13，95%CI 0.81～1.57，P =0.48）无显著性差异。结论与标准抗栓相比，急性缺血性卒中患者在接受阿替普酶静脉溶栓后24 h内给予早期抗栓治疗的90 d功能预后更好，并且不会增加症状性脑出血和死亡风险。

文章导读： 缺血性卒中静脉溶栓后早期抗栓治疗是否安全有效一直存在争议，本文对已发表的相关研究进行了Meta分析，发现就目前的研究汇总结果，溶栓后24 h内抗栓治疗患者的90 d功能预后较好，且出血风险没有增加。

关键词: 缺血性卒中; 阿替普酶; 静脉溶栓; 早期抗栓; 荟萃分析

Abstract:

Objective To explore the safety and efficacy of antithrombotic therapy in patients with acute ischemic stroke (AIS) in 24 hours after receiving intravenous alteplase thrombolytic therapy. Methods Literature search was carried out in PubMed, Cochrane Library (as of the 10th issue of 2017), EM base and Web of Science data base up to October 2017, for cohort studies on curative effect observation of comparing early antithrombotic therapy (within 24 h) with standard antithrombotic therapy (after 24 h) after altipase thrombolysis in AIS patients in randomized controlled trials, matched controlled trials and non-randomized controlled trials. According to inclusion and exclusion criteria, two reviewers independently screened literature, extracted data, and assessed methodological quality of included studies. Then meta-analysis was performed by using Stata 14.0, to compare the 90-day favorable outcome and mortality, and symptomatic intracranial hemorrhage (sICH) between the two groups. Results A total of 11 cohort studies (including 4 randomized controlled trials, 2 matched controlled trials and 5 non-randomized controlled trials) were finally included involving 2082 cases. The early antithrombotic group had 1219 cases (58.5%) and standard antithrombotic group had 863 cases (41.5%). The results of meta-analysis showed that the proportion of 90-day favorite outcome in early antithrombotic group was higher than in standard antithrombotic group [odds ratio (OR) 1.41, 95% confidence interval (CI) 1.15-1.73, P =0.001)]. However, there were no significant difference in sICH (OR 1.08, 95%CI 0.63-1.86, P =0.78) and 90-day mortality between both groups (OR 1.13, 95%CI 0.81-1.57, P =0.48). Conclusion Patients in early antithrombotic group(within 24 hours) after receiving intravenous alteplase thrombolytic therapy had a higher proportion of 90-day favorable outcome than in standard antithrombotic group (after 24 hours), and the risk of sICH and 90-day mortality had no difference between the both groups.

Key words: Ischemic stroke; Alteplase; Intravenous thrombolysis; Early antithrombotic therapy; Meta-analysis

李欣, 佟旭, 李晶晶, 裴洪菲, 王拥军, 王伊龙, 郑华光, 于萍, 曹亦宾. 急性缺血性卒中阿替普酶静脉溶栓后早期抗栓治疗安全性和有效性的荟萃分析[J]. 中国卒中杂志, 2018, 13(05): 430-436.

LI Xin, TONG Xu, LI Jing-Jing, PEI Hong-Fei, WANG Yong-Jun, WANG Yi-Long, ZHENG Hua-Guang, YU Ping, CAO Yi-Bin. Meta-analysis of Safety and Efficacy of Early Antithrombotic Therapy in Patients with Acute Ischemic Stroke after Intravenous Alteplase Thrombolysis[J]. Chinese Journal of Stroke, 2018, 13(05): 430-436.

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