阿加曲班或低分子肝素联合阿司匹林对于早期进展性缺血性卒中的疗效和安全性

Efficacy and safety of argatroban or low molecular weight heparin plus aspirin in early progressive ischemic stroke

目的:观察和比较阿加曲班或低分子肝素(LMWH)联合阿司匹林对于早期进展性缺血性卒中(PIS的疗效和安全性。方法:将95例符合标准的PIS患者随机分为两组,阿加曲班联合阿司匹林组48例(AA组),LMWH联合阿司匹林组47例(LA组)。比较两组治疗前后的美国国立卫生研究院卒中量表(NIHSS)、日常生活能力评定量表(Barthel指数)、改良Rankin量表(mRS)。同时监测血红蛋白(Hb)浓度、血小板(PLT)计数、活化部分凝血酶原时间(APTT)、超敏C反应蛋白(hs-CRP)浓度、药物不良反应发生情况。结果:治疗7 d后,两组与治疗前相比均有一定疗效,AA组总有效率显著高于LA组(P<0.05)。治疗后AA组NIHSS评分低于LA组(P<0.05),Barthel指数明显高于LA组(P<0.01)。AA组治疗3个月后mRS评分明显低于LA组(P<0.01)。同时,治疗3个月时的mRS0-1评分占比相比,AA组优于LA组(P<0.05)。此外,AA组治疗后APTT长于LA组(P<0.01),LA组PLT较AA组降低(P<0.01)。两组治疗后Hb差异无统计学意义(P>0.05)。AA组和LA组的不良反应分别为4.17%和8.51%,均为非致命性反应,差异无统计学意义(P>0.05)。结论:对于PIS,阿加曲班或LMWH联合阿司匹林均可以改善临床症状,而且出血风险相对较低。相比之下,阿加曲班可能可以更好地促进神经功能缺损的恢复,提高日常生活能力,同时不会增加药物的不良反应。

Objective:To observe and compare the efficacy and safety of aspirin combined with argatroban or low molecular weight heparin(LMWH)in the progressive ischemic stroke(PIS).Methods:95 patients with PIS who met the criteria were randomly divided into two groups,48 cases in the argatroban plus aspirin group(AA group)and 47 cases in the LMWH plus aspirin group(LA group).The National Institutes of Health Stroke Scale(NIHSS)score,the Activities of Daily Living(Barthel)index,and the modified Rankin Scale(mRS)score were compared between the two groups before and after treatment.At the same time,the hemoglobin(Hb)concentration,platelet(PLT)count,activated partial prothrombin time(APTT),high-sensitivity C-reactive protein(hs-CRP)concentration,and the occurrence of adverse drug reactions were monitored.Results:After 7 days of treatment,both groups had certain efficacy compared with those before treatment.The total effective rate of AA group was significantly higher than that of LA group(P<0.05).After treatment,the NIHSS score in the AA group was significantly lower than that in the LA group(P<0.05),and the Barthel index was significantly increased than the LA group(P<0.01).The mRS score in the AA group was significantly reduced than that in the LA group after 3 months of treatment(P<0.01).Moreover,compared with the mRS0-1 score at 3 months of treatment,argatroban was superior to the LMWH(P<0.05).Meanwhile,the APTT in the AA group was longer than that in the LA group after treatment(P<0.01)and the PLT in the LA group was reduced than AA group(P<0.01).There was no significant difference in Hb between the two groups after treatment(P>0.05).The adverse reactions of AA group and LA group were 4.17%and 8.51%,respectively,with no significant statistical difference(P>0.05).Conclusion:For patients with PIS,aspirin plus argatroban or LMWH both can improve the clinical symptoms and the risk of bleeding is low.In comparison,argatroban can better promote the recovery of neurological deficits and improve the ability of daily living,without increasing the adverse reactions of drugs.