心源性栓塞患者rt-PA静脉溶栓前阿司匹林联合氯吡格雷预处理的有效性和安全性分析

Study on the efficacy and safety of aspirin combined with clopidogrel pretreatment before rt-PA intravenous thrombolysis in patients with cardioembolism

目的探讨心源性栓塞患者rt-PA静脉溶栓前阿司匹林联合氯吡格雷双联抗血小板预处理的有效性和安全性。方法2018年7月至2019年7月共313例心源性栓塞患者均接受rt-PA静脉溶栓治疗,溶栓前予阿司匹林联合氯吡格雷预处理167例(预处理组),未服药146例(对照组),采用美国国立卫生研究院卒中量表(NIHSS)评价近期(溶栓后1 h、24 h和7 d)神经功能改善,改良Rankin量表(mRS)评价远期(发病后90 d)预后,并记录颅内出血发生率和病死率。结果预处理组患者静脉溶栓后1 h[48.50%(81/167)对32.19%(47/146);χ~2=8.574,P=0.003]、24 h[57.49%(96/167)对45.21%(66/146);χ~2=4.704,P=0.030]和7 d[77.25%(129/167)对63.01%(92/146);χ~2=7.602,P=0.006]神经功能改善率均高于对照组,而两组溶栓后颅内出血发生率[3.59%(6/167)对3.42%(5/146);χ~2=0.006,P=0.936]、病死率[0.60%(1/167)对0.68%(1/146);Fisher确切概率法:P=1.000]和发病后90 d预后良好率[80.84%(135/167)对74.66%(109/146);χ~2=1.732,P=0.188]差异均无统计学意义。结论rt-PA静脉溶栓前阿司匹林联合氯吡格雷双联抗血小板预处理可以改善心源性栓塞患者早期神经功能,且不增加颅内出血和死亡风险,临床应用安全、有效。

Objective To investigate the efficacy and safety of aspirin combined with clopidogrel pretreatment before intravenous thrombolysis with rt-PA in patients with cardioembolism(CE).Methods Three hundred and thirteen patients with CE treated with rt-PA intravenous thrombolysis from July 2018 to July 2019 were admitted.Among them,167 patients were pretreated with aspirin combined with clopidogrel before thrombolysis(pretreatment group),and 146 patients were not(control group).The short-term improvement of neurological function(1 h,24 h and 7 d after thrombolysis)was evaluated by National Institutes of Health Stroke Scale(NIHSS).The long-term prognosis(90 d after onset)was evaluated by modified Rankin Scale(mRS),and mortality and the incidence of intracranial hemorrhage(ICH)within 90 d after onset were recorded.Results The neurological function improvement rates in the pretreatment group at 1 h,24 h and 7 d after intravenous thrombolysis were higher than those in control group[48.50%(81/167)vs.32.19%(47/146),χ~2=8.574,P=0.003;57.49%(96/167)vs.45.21%(66/146),χ~2=4.704,P=0.030;77.25%(129/167)vs.63.01%(92/146),χ~2=7.602,P=0.006].The incidence of ICH after thrombolysis[3.59%(6/167)vs.3.42%(5/146);χ~2=0.006,P=0.936],mortality[0.60%(1/167)vs.0.68%(1/146);Fisher’s exact probability:P=1.000]and the rate of good prognosis within 90 d after onset[80.84%(135/167)vs.74.66%(109/146);χ~2=1.732,P=0.188]between 2 groups were no significant difference.Conclusions Aspirin combined with clopidogrel pretreatment before intravenous thrombolysis can improve early neurological function in patients with CE,and does not increase the risk of ICH.It is safe and effective for clinical application.