Associations of new intracranial haemorrhage, ischaemic stroke and survival with dual antiplatelet therapy regimen or duration after endovascular treatment for ruptured cerebral aneurysm.

IF 4.9 1区 医学
Pang-Shuo Perng, Yu Chang, Ming-Tsung Chuang, Chia-En Wong, Yuan-Ting Sun, Hao-Kuang Wang, Jung-Shun Lee, Liang-Chao Wang, Chih-Yuan Huang
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引用次数: 0

Abstract

Background: Dual antiplatelet therapy (DAPT) is often necessary following endovascular treatment for ruptured cerebral aneurysms; however, the optimal drug combination and treatment duration remain uncertain.

Method: Patients with subarachnoid haemorrhage secondary to ruptured cerebral aneurysms were identified from the TriNetX database. Subjects were categorised based on DAPT regimen (aspirin+clopidogrel vs aspirin+ticagrelor) and duration (≥1 month, ≥3 months, ≥6 months). Propensity score matching was performed, and outcomes including new onset intracranial haemorrhage, ischaemic stroke and overall survival were compared.

Results: A total of 2775 patients were included in the regimen analysis, with 725 matched in each group. At the 1-month follow-up, the ORs for new intracranial haemorrhage and ischaemic stroke in the aspirin+clopidogrel group were 1.11 (95% CI 0.71 to 1.75) and 0.97 (95% CI 0.59 to 1.59), respectively, with no significant differences at mid-term or long-term follow-up. However, survival analysis revealed a statistically significant difference at the 6-month follow-up favouring the clopidogrel group (OR 0.65; 95% CI, 0.44 to 0.97). In the duration analysis, 465 patients were matched for the 1-month versus 3-month groups, and 355 for the 3-month versus 6-month groups. ORs for ischaemic stroke were 1.06 (95% CI 0.67 to 1.67) and 1.24 (95% CI 0.76 to 2.01), respectively. No significant differences in survival were observed based on log-rank tests.

Conclusion: Our real-world data analysis revealed no significant differences in ischaemic or haemorrhagic outcomes between the aspirin+clopidogrel and aspirin+ticagrelor regimens. However, the observed differences in survival suggest the need for more refined patient selection strategies. In addition, the appropriate duration of DAPT is still unknown, although our results suggest that a shorter DAPT duration may offer comparable safety and efficacy.

双重抗血小板治疗方案或脑动脉瘤破裂后血管内治疗持续时间与新发颅内出血、缺血性卒中和生存的关系
背景:双重抗血小板治疗(DAPT)是脑动脉瘤破裂血管内治疗后经常需要的;然而,最佳的药物组合和治疗时间仍不确定。方法:从TriNetX数据库中识别脑动脉瘤破裂继发蛛网膜下腔出血患者。受试者根据DAPT方案(阿司匹林+氯吡格雷vs阿司匹林+替格瑞洛)和持续时间(≥1个月、≥3个月、≥6个月)进行分类。进行倾向评分匹配,并比较新发颅内出血、缺血性卒中和总生存期等结果。结果:方案分析共纳入2775例患者,每组匹配725例。随访1个月时,阿司匹林+氯吡格雷组新发颅内出血和缺血性卒中的or分别为1.11 (95% CI 0.71 ~ 1.75)和0.97 (95% CI 0.59 ~ 1.59),中期和长期随访无显著差异。然而,生存分析显示,在6个月的随访中,氯吡格雷组有统计学显著差异(OR 0.65; 95% CI, 0.44至0.97)。在持续时间分析中,465名患者被匹配为1个月组和3个月组,355名患者被匹配为3个月组和6个月组。缺血性卒中的or分别为1.06 (95% CI 0.67 ~ 1.67)和1.24 (95% CI 0.76 ~ 2.01)。基于对数秩检验,生存率无显著差异。结论:我们的真实世界数据分析显示,阿司匹林+氯吡格雷和阿司匹林+替格瑞洛方案在缺血性或出血结局方面没有显著差异。然而,观察到的生存差异表明需要更精细的患者选择策略。此外,DAPT的适当持续时间仍然未知,尽管我们的结果表明,较短的DAPT持续时间可能提供相当的安全性和有效性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Journal of Investigative Medicine
Journal of Investigative Medicine MEDICINE, GENERAL & INTERNALMEDICINE, RESE-MEDICINE, RESEARCH & EXPERIMENTAL
自引率
0.00%
发文量
111
期刊介绍: Journal of Investigative Medicine (JIM) is the official publication of the American Federation for Medical Research. The journal is peer-reviewed and publishes high-quality original articles and reviews in the areas of basic, clinical, and translational medical research. JIM publishes on all topics and specialty areas that are critical to the conduct of the entire spectrum of biomedical research: from the translation of clinical observations at the bedside, to basic and animal research to clinical research and the implementation of innovative medical care.
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