脑静脉窦血栓的抗凝治疗：倾向评分匹配研究和逆概率加权。

IF 3.6 3区医学 Q2 CLINICAL NEUROLOGY

Neurocritical Care Pub Date : 2025-10-01 Epub Date: 2025-03-04 DOI:10.1007/s12028-025-02225-0

Kai Liu, Mengmeng Zhang, Jiawei Zhao, Qinqin Dai, Yuan Gao, Shen Li, Lu Zhao, Yuming Xu, Bo Song

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引用次数: 0

摘要

背景：新型口服抗凝剂（NOACs）对脑静脉窦血栓形成（CVST）患者具有潜在的优势。目前尚无证据评价noac治疗CVST的疗效和安全性。本研究的目的是比较NOACs和华法林在CVST患者中的获益和安全性。方法：我们对2018年1月1日至2021年12月31日郑州大学第一附属医院的CVST患者进行了单中心前瞻性分析。主要结局是6个月随访期间复发性血栓事件。次要结局包括改良兰金量表（mRS）评分、出血事件、死亡和抗凝治疗期间脑静脉再通。本研究利用倾向得分匹配（PSM）和逆概率加权（IPTW）来平衡组间协变量，减轻选择偏差。结果：共发现650例患者。184例患者使用noac， 466例患者使用华法林。IPTW或PSM后各组基线特征平衡。1:2和1:3 PSM后，两组患者的死亡率（2.2% vs. 8.0%, P = 0.014）和mRS评分≤2分（95分）比较，差异均有统计学意义。1%比88.7%,P = 0.020)。但两组复发性CVST差异无统计学意义(优势比[OR] 0.543；95%置信区间[CI] 0.258 ~ 1.143；p = 0。108)，出血事件(OR 0.823；95% ci 0.074-9.143；P = 0.874)，部分/完全再通(OR 0.980；95% ci 0.546-1.760；P = 0.946)。同样，在接受抗凝治疗的患者和接受血管内治疗加抗凝治疗的患者中，任何临床结果都没有显著差异。这些结果在IPTW分析后仍然相似。结论：我们的研究表明，与华法林治疗相比，在CVST中使用NOACs具有相似的疗效和安全性。NOACs治疗可改善CVST患者的临床预后。

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Anticoagulant Therapy for Cerebral Venous Sinus Thrombosis: A Propensity Score Matching Study and Inverse Probability Weighting.

Background: New oral anticoagulants (NOACs) offer potential advantages for patients with cerebral venous sinus thrombosis (CVST). There is a lack of evidence to evaluate the efficacy and safety of NOACs in CVST. The purpose of this study was to compare the benefit and safety between NOACs and warfarin in patients with CVST.

Methods: We performed a single-center prospective analysis including patients with CVST from the First Affiliated Hospital of Zhengzhou University between January 1, 2018, and December 31, 2021. The primary outcome was recurrent thrombotic events during the 6-month follow-up. Secondary outcomes included the modified Rankin scale (mRS) score, bleeding events, death, and cerebral venous recanalization during anticoagulant therapy. Propensity score matching (PSM) and inverse probability weighting (IPTW) were utilized to balance covariates between groups and mitigate selection bias in our study.

Results: A total of 650 patients were identified. NOACs were used in 184 patients, and warfarin was used in 466 patients. Baseline characteristics were balanced between groups after IPTW or PSM. After 1:2 and 1:3 PSM, there were statistically significant differences between the two groups in death (2.2% vs. 8.0%, P = 0.014) and in mRS scores ≤ 2 (95. 1% vs. 88.7%, P = 0.020) in all patients. But there were no statistically significant differences between the two groups in recurrent CVST (odds ratio [OR] 0.543; 95% confidence interval [CI] 0.258-1.143; P = 0. 108), bleeding events (OR 0.823; 95% CI 0.074-9.143; P = 0.874), and partial/complete recanalization (OR 0.980; 95% CI 0.546-1.760; P = 0.946) in all patients. Similarly, there were no significant differences in patients who received anticoagulation therapy and in patients who received endovascular therapy plus anticoagulation therapy regarding any of the clinical outcomes. These results remained similar after IPTW analysis.

Conclusions: Our study demonstrates that the use of NOACs in CVST has similar efficacy and safety compared to warfarin treatment. NOACs treatment may improve the clinical prognosis in patients with CVST.

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来源期刊

Neurocritical Care 医学-临床神经学

CiteScore

7.40

自引率

8.60%

发文量

221

审稿时长

4-8 weeks

期刊介绍： Neurocritical Care is a peer reviewed scientific publication whose major goal is to disseminate new knowledge on all aspects of acute neurological care. It is directed towards neurosurgeons, neuro-intensivists, neurologists, anesthesiologists, emergency physicians, and critical care nurses treating patients with urgent neurologic disorders. These are conditions that may potentially evolve rapidly and could need immediate medical or surgical intervention. Neurocritical Care provides a comprehensive overview of current developments in intensive care neurology, neurosurgery and neuroanesthesia and includes information about new therapeutic avenues and technological innovations. Neurocritical Care is the official journal of the Neurocritical Care Society.