急性缺血性脑卒中肺栓塞的治疗策略:系统回顾

IF 1.6 Q2 MEDICINE, GENERAL & INTERNAL
Journal of clinical medicine research Pub Date : 2025-01-01 Epub Date: 2025-01-14 DOI:10.14740/jocmr6153
Sheilabi Seeburun, Carlos Valladares, Jose Iglesias
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引用次数: 0

摘要

肺栓塞(PE)和急性缺血性脑卒中(AIS)是高发病率和死亡率的严重疾病。在美国,PE每年导致约10万人死亡,其中男性发病率更高。PE后AIS发生率为1-10%,是卒中后2 - 4周内死亡的主要原因。由于需要抗凝治疗,同时处理PE和AIS是复杂的,这是AIS溶栓后的禁忌。本综述评估了各种PE治疗-抗凝、溶栓和栓塞切除术-对两种情况患者死亡率的影响。根据PRISMA 2020指南,从2010年1月至2023年12月对六个数据库进行了系统评价。测量的主要结果是死亡率,比较治疗与未治疗的PE患者。次要结局包括明显的症状改善、症状轻微改善或恶化以及并发症。对数据进行描述性分析,总结患者人口统计学、临床特征和治疗结果。治疗方式,如抗凝、溶栓、导管取栓、手术取栓和保守治疗,根据其对症状改善、生存和死亡率的影响进行评估。对6个数据库的初步查询产生了1679篇文章,经过彻底审查后只剩下21篇。溶栓导致100%的症状改善和生存率,死亡率为0%。62.5%的患者经抗凝治疗后症状得到改善并存活,死亡率为12.5%。导管引导和外科取栓分别有66.7%和75%的患者症状改善和生存,无死亡。保守治疗,这里定义为没有抗凝或溶栓治疗的治疗,与症状恶化或无改善和50%死亡率相关。本系统综述基于病例报告的观察性数据,强调了医生使用的不同策略。积极和积极的治疗,特别是溶栓治疗,显示出更好的结果和更低的死亡率。然而,不能仅从这些结果中提出具体建议,强调需要精心设计的前瞻性随机对照试验来为医疗保健提供者设计结构化指南。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Strategies in Management of Pulmonary Embolism With Acute Ischemic Stroke: A Systematic Review.

Pulmonary embolism (PE) and acute ischemic stroke (AIS) are serious conditions with high morbidity and mortality. In the USA, PE causes around 100,000 deaths annually, with higher incidence in males. AIS following PE occurs in 1-10% of cases and is a leading cause of death within 2 - 4 weeks post-stroke. Managing concurrent PE and AIS is complex due to the need for anticoagulation, which is contraindicated after thrombolysis for AIS. This review evaluates the impact of various PE treatments - anticoagulation, thrombolysis, and embolectomy - on mortality in patients with both conditions. Following PRISMA 2020 guidelines, a systematic review was conducted across six databases from January 2010 to December 2023. The primary outcome measured was mortality, comparing treated vs. untreated patients for PE. Secondary outcomes included marked symptom improvement, slight improvement or deterioration of symptoms, and the complications. Data were analyzed descriptively, summarizing patient demographics, clinical characteristics, and treatment outcomes. Treatment modalities, such as anticoagulation, thrombolysis, catheter-directed thrombectomy, surgical thrombectomy, and conservative management, were evaluated based on their impact on symptom improvement, survival, and mortality. Initial querying of six databases yielded 1,679 articles, with only 21 remaining after a thorough review. Thrombolysis led to 100% symptom improvement and survival, with 0% mortality. Anticoagulation resulted in symptom improvement and survival in 62.5% of cases, with a 12.5% mortality rate. Catheter-directed and surgical thrombectomy had symptom improvement and survival in 66.7% and 75% of cases, respectively, with no mortality. Conservative management, defined here as management without anticoagulation or thrombolytic therapy, was associated with symptom worsening or no improvement and 50% mortality. This systematic review, based on observational data from case reports, highlights the diverse strategies used by physicians. Proactive and aggressive treatments, especially thrombolysis, show better outcomes and lower mortality rates. However, specific recommendations cannot be made from these results alone, emphasizing the need for well-designed prospective, randomized controlled trials to design structured guidelines for healthcare providers.

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