缺血性脑卒中患者合并小腿肌间静脉血栓形成抗栓治疗效果的影响因素分析

Influence factors of anti-thrombotic therapy in patients with ischemic stroke complicated with calf muscle venous thrombosis

目的探讨缺血性脑卒中(IS)患者小腿肌间静脉血栓(CMVT)形成抗栓治疗效果的影响因素。方法将149例IS合并CMVT患者根据是否使用利伐沙班治疗,分为无利伐沙班组(67例)和利伐沙班组(82例),收集并比较2组患者的临床基线资料。随访记录2组患者治疗后的无效事件和出血事件,多因素Logistic回归分析患者发生无效事件和出血事件的危险因素。结果无利伐沙班组患者肌酐清除率(CLcr)<50 mL/min、美国国立卫生研究院卒中量表(NIHSS)评分、合并冠心病、陈旧性脑出血、胃溃疡史、感染史、合用阿司匹林、1.4 mmol/L<低密度脂蛋白胆固醇(LDL-C)≤1.8 mmol/L、非高密度脂蛋白胆固醇(non-HDL-C)<2.2 mmol/L比例显著高于利伐沙班组,1.8 mmol/L<LDL-C≤2.6 mmol/L、合并高血压、合用他汀类药物比例显著低于利伐沙班组(P<0.05)。无利伐沙班组治疗无效事件发生率明显高于利伐沙班组,出血事件发生率明显低于利伐沙班组(P<0.01)。Logistic回归分析显示,未使用利伐沙班、陈旧性脑出血是发生无效事件的独立危险因素(P<0.05),使用利伐沙班、NIHSS评分增加是发生出血事件的独立危险因素(P<0.05)。结论使用利伐沙班能够降低IS合并CMVT患者无效事件发生风险,但同时增加了出血事件的发生风险。

Objective To explore the influence factors of anti-thrombotic therapy in patients with ischemic stroke(IS)complicated with calf muscular vein thrombosis(CMVT).Methods A total of 149 patients with IS complicated with CMVT were divided into the non-rivaroxaban group(n=67)and the rivaroxaban group(n=82)according to whether they were treated with rivaroxaban or not.The clinical baseline data were collected and compared between the two groups.After treatment,ineffective events and bleeding events were recorded in the 2 groups,and the risk factors of ineffective events and bleeding events were analyzed by Logistic regression.Results In the non-rivaroxaban group,the proportion of creatinine clearance rate(CLcr)<50 mL/min,National Institutes of Health Stroke Scale(NIHSS)score,complicated coronary heart disease,old cerebral hemorrhage,history of gastric ulcer,history of infection,using aspirin together,1.4 mmol/L<low density lipoprotein cholesterol(LDL-C)≤1.8 mmol/L and non high density lipoprotein cholesterol(non-HDL-C)<2.2 mmol/L were significantly higher than those of the rivaroxaban group,and the proportion of 1.8 mmol/L<LDL-C≤2.6 mmol/L,combined hypertension and using statin were significantly lower(P<0.05).The incidence of ineffective events was significantly higher in the nonrivaroxaban group than that in the rivaroxaban group,and the incidence of bleeding events was significantly lower than that in the rivaroxaban group(P<0.01).Logistic regression analysis showed that rivaroxaban was not used and old cerebral hemorrhage were independent risk factors for ineffective events(P<0.05),while using rivaroxaban and increased NIHSS score were independent risk factors for bleeding events(P<0.05).Conclusion Rivaroxaban can be used to reduce the incidence of ineffective events in IS patients with CMVT while increasing the incidence of bleeding events.