缺血性脑心血管疾病患者血栓弹力图指导下的抗血小板治疗：系统回顾和荟萃分析。

IF 2.2 3区医学 Q3 CLINICAL NEUROLOGY

Cerebrovascular Diseases Pub Date : 2024-07-04 DOI:10.1159/000539976

Song He, Quandan Tan, Haifeng Shao, Fengkai Mao, Xinyi Leng, Weihua Liu, Xiaoling Chen, Hongwei Deng, Yijie Gao, Kejie Chen, Junli Hao, Yapeng Lin, Jie Yang, Xia Wang

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引用次数: 0

摘要

背景：缺血性脑心血管疾病患者在血栓弹力图（TEG）指导下进行抗血小板治疗的有效性尚未得到充分证实。本系统性综述评估了缺血性脑心血管疾病患者在 TEG 指导下进行抗血小板治疗与标准治疗相比的有效性和安全性：方法：研究人员对缺血性脑卒中（IS）或冠状动脉疾病（CAD）患者进行了随机对照试验（RCT）和观察性研究，将 TEG 引导下的抗血小板疗法与标准疗法进行了比较。主要疗效指标是缺血性和出血性事件的复合指标。次要疗效指标包括任何缺血性事件，而安全性则根据出血事件的发生情况进行评估：结果：共纳入了 10 项研究，包括 4 项研究性临床试验和 6 项观察性研究，共计 1,678 名患者。考虑到研究性试验中缺血和出血事件的复合情况，与标准疗法相比，在 TEG 引导下接受治疗的 IS 或 CAD 患者的发病率显著降低（OR 0.45，95% CI 0.27 至 0.75，P=0.002）。将研究性临床试验和观察性研究集中在一起后，与标准抗血小板疗法相比，TEG引导疗法显著降低了缺血性和出血性事件的复合风险（OR 0.26，95% CI 0.19至0.37；P<0.00001）、缺血性事件（OR 0.28，95% CI 0.19至0.41；P<0.00001）和出血事件（OR 0.31，95% CI 0.16至0.62；P=0.0009）的风险：TEG指导下的抗血小板治疗对IS或CAD患者似乎既有效又安全。这些研究结果支持使用 TEG 检测为缺血性脑心血管疾病患者量身定制抗血小板疗法。

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Thromboelastography-Guided Antiplatelet Therapy for Patients with Ischemic Cerebrocardiovascular Diseases: A Systematic Review and Meta-Analysis.

Introduction: The effectiveness of thromboelastography (TEG)-guided antiplatelet therapy in patients with ischemic cerebrocardiovascular diseases is not well-established. This systematic review evaluates the efficacy and safety of TEG-guided antiplatelet therapy compared to standard treatment in patients with ischemic cerebrocardiovascular diseases.

Methods: Randomized controlled trials (RCTs) and observational studies comparing TEG-guided antiplatelet therapy with standard therapy in patients suffering from ischemic stroke (IS) or coronary artery disease (CAD) were identified. The primary efficacy measure was a composite of ischemic and hemorrhagic events. Secondary efficacy measures included any ischemic events, while safety was assessed by the occurrence of bleeding events.

Results: Ten studies involving 4 RCTs and 6 observational studies with a total of 1,678 patients were included. When considering a composite of ischemic and hemorrhagic events in RCTs, a significant reduction was observed in IS or CAD patients under TEG-guided therapy compared to standard therapy (OR: 0.45, 95% CI: 0.27-0.75, p = 0.002). After pooling RCTs and observational studies together, compared to standard antiplatelet therapy, TEG-guided therapy significantly reduced the risk of a composite of ischemic and hemorrhagic events (OR: 0.26, 95% CI: 0.19-0.37; p < 0.00001), ischemic events (OR: 0.28, 95% CI: 0.19-0.41; p < 0.00001), and bleeding events (OR: 0.31, 95% CI: 0.16-0.62; p = 0.0009) in patients with IS or CAD.

Conclusion: TEG-guided antiplatelet therapy appears to be both effective and safe for patients with IS or CAD. These findings support the use of TEG testing to tailor antiplatelet therapy in individuals with ischemic cerebrocardiovascular diseases.

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来源期刊

Cerebrovascular Diseases 医学-临床神经学

CiteScore

4.50

自引率

0.00%

发文量

审稿时长

1 months

期刊介绍： A rapidly-growing field, stroke and cerebrovascular research is unique in that it involves a variety of specialties such as neurology, internal medicine, surgery, radiology, epidemiology, cardiology, hematology, psychology and rehabilitation. ''Cerebrovascular Diseases'' is an international forum which meets the growing need for sophisticated, up-to-date scientific information on clinical data, diagnostic testing, and therapeutic issues, dealing with all aspects of stroke and cerebrovascular diseases. It contains original contributions, reviews of selected topics and clinical investigative studies, recent meeting reports and work-in-progress as well as discussions on controversial issues. All aspects related to clinical advances are considered, while purely experimental work appears if directly relevant to clinical issues.