评估管道栓塞装置治疗前24小时600mg氯吡格雷负荷剂量

JHN Journal Pub Date : 1900-01-01 DOI:10.29046/JHNJ.013.2.002

E. Atallah, H. Saad, K. Bekelis, N. Chalouhi, S. Tjoumakaris, D. Hasan, H. Zarzour, Michelle J. Smith, Md Mba Facs Faha Robert H. Rosenwasswer, P. Jabbour

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The mean follow-up was 15.8 months (standard deviation [SD] 12.4 months). modified Rankin Scale (mRS) was registered before the discharge and at each follow-up visit. To control confounding, we used multivariable logistic regression and propensity score conditioning. Results: Of 398 patients, the proportion of female patients was ~16.5% (41/240) in both groups and shared the same mean of age ~56.46 years. ~12.2% (mean = 0.09; SD = 0.30) had a subarachnoid hemorrhage. 92% (mean = 0.29; SD = 0.70) from the pretreatment group and 85.7% (mean = 0.44; SD = 0.91) of the bolus group had a mRS ≤2. In multivariate analysis, bolus did not affect the mRS score, P = 0.24. Seven patients had a long-term recurrence, 2 (0.83%; mean = 0.01; SD = 0.10) of which from the pretreatment group. 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引用次数: 0

摘要

背景:氯吡格雷/阿司匹林抗血小板治疗通常在管道动脉瘤治疗前7-10天进行。我们的研究评估了在管道栓塞装置(PED)治疗前24小时使用600mg负荷剂量氯吡格雷的安全性和有效性。方法:在这项回顾性队列研究中，我们纳入了2010年10月至2016年5月期间接受PED治疗的患者。共有39.7% (n = 158)的患者在PED部署前24小时分配了650 mg阿司匹林和至少600 mg氯吡格雷的负荷剂量，相比之下，60.3% (n = 240)的患者在术前每天接受81-325 mg阿司匹林和75 mg氯吡格雷，持续10天。平均随访15.8个月(标准差12.4个月)。在出院前和每次随访时登记改良Rankin量表(mRS)。为了控制混杂，我们使用了多变量逻辑回归和倾向评分条件反射。结果:398例患者中，两组女性患者所占比例为~16.5%(41/240)，平均年龄为~56.46岁。~12.2%(平均= 0.09;SD = 0.30)有蛛网膜下腔出血。92%(平均= 0.29;SD = 0.70)， 85.7%(平均= 0.44;SD = 0.91)的大剂量组mRS≤2。在多因素分析中，丸剂对mRS评分无影响，P = 0.24。长期复发7例，2例(0.83%;平均值= 0.01;SD = 0.10)，与预处理组比较。在多变量logistic回归中，bolus与长期复发率无关(比值比[OR] 1.91;95%置信区间[CI] 0.27-13.50;P = 0.52)或血栓栓塞事故(or 0.99;95% ci 0.96-1.03;P = 0.83)与出血事件无关(OR 1.00;95% ci 0.97-1.03;P = 0.99)。三名患者死亡:其中一名接受静脉注射的患者出现急性蛛网膜下腔出血。两组患者的平均死亡率相当~0.25 (SD = 0.16)。Bolus与死亡率无关(OR 1.11;95% ci 0.26-4.65;P = 0.89)。同样的关联也存在于倾向得分调整模型中。

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Assessing a 600-mg Loading Dose of Clopidogrel 24 Hours Prior to Pipeline Embolization Device Treatment

Background: Clopidogrel/aspirin antiplatelet therapy routinely is administered 7-10 days before pipeline aneurysm treatment. Our study assessed the safety and efficacy of a 600-mg loading dose of clopidogrel 24 hours before Pipeline Embolization Device (PED) treatment. Methods: In this retrospective cohort study, we included patients treated with PED from October 2010 to May 2016. A total of 39.7% (n = 158) of patients were dispensed a loading dose of 650 mg of aspirin plus at least 600 mg of clopidogrel 24 hours preceding PED deployment, compared to 60.3% (n = 240) of patients who received 81-325 mg of aspirin daily for 10 days with 75 mg of clopidogrel daily preprocedurally. The mean follow-up was 15.8 months (standard deviation [SD] 12.4 months). modified Rankin Scale (mRS) was registered before the discharge and at each follow-up visit. To control confounding, we used multivariable logistic regression and propensity score conditioning. Results: Of 398 patients, the proportion of female patients was ~16.5% (41/240) in both groups and shared the same mean of age ~56.46 years. ~12.2% (mean = 0.09; SD = 0.30) had a subarachnoid hemorrhage. 92% (mean = 0.29; SD = 0.70) from the pretreatment group and 85.7% (mean = 0.44; SD = 0.91) of the bolus group had a mRS ≤2. In multivariate analysis, bolus did not affect the mRS score, P = 0.24. Seven patients had a long-term recurrence, 2 (0.83%; mean = 0.01; SD = 0.10) of which from the pretreatment group. In a multivariable logistic regression, bolus was not associated with a long-term recurrence rate (odds ratio [OR] 1.91; 95% confidence interval [CI] 0.27-13.50; P = 0.52) or with thromboembolic accidents (OR 0.99; 95% CI 0.96-1.03; P = 0.83) nor with hemorrhagic events (OR 1.00; 95% CI 0.97-1.03; P = 0.99). Three patients died: one who received a bolus had an acute subarachnoid hemorrhage. The mean mortality rate was parallel in both groups ~0.25 (SD = 0.16). Bolus was not associated with mortality (OR 1.11; 95% CI 0.26-4.65; P = 0.89). The same associations were present in propensity score-adjusted models.

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JHN Journal

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