Safety of early antiplatelet therapy for non-cardioembolic mild stroke patients with thrombocytopenia. / å并è¡å°æ¿åå°ççéå¿æºæ§è½»åèåä¸æ£è
æ©ææè¡å°æ¿æ²»ççå®å
¨æ§ç 究.
Zhejiang Da Xue Xue Bao Yi Xue Ban
; 53(2): 175-183, 2024 Apr 25.
Article
in En, Zh
| MEDLINE
| ID: mdl-38531768
ABSTRACT
OBJECTIVES:
To investigate the safety of early antiplatelet therapy for non-cardioembolic mild stroke patients with thrombocytopenia.METHODS:
Data of acute ischemic stroke patients with baseline National Institutes of Health Stroke Scale (NIHSS) score ≤3 and a platelet count <100×109/L were obtained from a multicenter register. Those who required anticoagulation or had other contraindications to antiplatelet therapy were excluded. Short-term safety outcomes were in-hospital bleeding events, while the long-term safety outcome was a 1-year all-cause death. The short-term neurological outcomes were evaluated by modified Rankin scale (mRS) score at discharge.RESULTS:
A total of 1868 non-cardioembolic mild stroke patients with thrombocytopenia were enrolled. Multivariate regression analyses showed that mono-antiplatelet therapy significantly increased the proportion of mRS score of 0-1 at discharge (OR=1.657, 95%CI 1.253-2.192, P<0.01) and did not increase the risk of intracranial hemorrhage (OR=2.359, 95%CI 0.301-18.503, P>0.05), compared with those without antiplatelet therapy. However, dual-antiplatelet therapy did not bring more neurological benefits (OR=0.923, 95%CI 0.690-1.234, P>0.05), but increased the risk of gastrointestinal bleeding (OR=2.837, 95%CI 1.311-6.136, P<0.01) compared with those with mono-antiplatelet therapy. For patients with platelet counts ≤75×109/L and >90×109/L, antiplatelet therapy significantly improved neurological functional outcomes (both P<0.05). For those with platelet counts (>75-90)×109/L, antiplatelet therapy resulted in a significant improvement of 1-year survival (P<0.05). For patients even with concurrent coagulation abnormalities, mono-antiplatelet therapy did not increase the risk of various types of bleeding (all P>0.05) but improved neurological functional outcomes (all P<0.01). There was no significant difference in the occurrence of bleeding events, 1-year all-cause mortality risk, and neurological functional outcomes between aspirin and clopidogrel (all P>0.05).CONCLUSIONS:
For non-cardioembolic mild stroke patients with thrombocytopenia, antiplatelet therapy remains a reasonable choice. Mono-antiplatelet therapy has the same efficiency as dual-antiplatelet therapy in neurological outcome improvement with lower risk of gastrointestinal bleeding.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Thrombocytopenia
/
Platelet Aggregation Inhibitors
/
Stroke
Limits:
Aged
/
Female
/
Humans
/
Male
/
Middle aged
Language:
En
/
Zh
Journal:
Zhejiang Da Xue Xue Bao Yi Xue Ban
Journal subject:
MEDICINA
Year:
2024
Document type:
Article
Affiliation country:
China