发病前口服抗栓药物对急性缺血性卒中患者静脉溶栓安全性的影响研究

目的 探索发病前口服抗栓药物对急性缺血性卒中患者静脉溶栓安全性的影响。方法 研究对象为2018年1-12月的全国、多中心、缺血性卒中住院患者登记研究中进行了rt-PA静脉溶栓的患者。根据患者发病前是否应用抗栓药物，将患者分为观察组（发病前口服抗栓药物）和对照组（发病前未口服抗栓药物）。比较两组的基线信息、溶栓后症状性颅内出血率和在院全因死亡率的差异，并采用多因素回归分析发病前应用抗栓药物对患者溶栓后住院期间安全性的影响。结果 本研究共纳入了全国1374家医院的17 587例rt-PA静脉溶栓的急性缺血性卒中住院患者。其中，有3313例（18.8%）发病前应用抗栓药物，纳入观察组，14 274例（81.2%）发病前未应用口服抗栓药物，纳入对照组。与对照组相比，观察组患者年龄较高（67.7±11.1岁 vs 64.8±12.2岁），男性比例较低（63.6% vs 65.7%），既往血管危险因素比例较高，入院NIHSS＞15分的患者比例较高（16.1% vs 13.5%），差异均有统计学意义。观察组溶栓后症状性颅内出血的发生率（0.12% vs 0.07%，P =0.156）和在院全因死亡率（1.72% vs 1.16%，P =0.010）均高于对照组，但多因素校正后，两组溶栓后症状性颅内出血（HR 1.133，95%CI 0.220～5.822，P =0.881）和在院全因死亡（HR 0.912，95%CI0.612～1.359，P =0.651）方面的差异均未达统计学意义。结论 发病前应用抗栓药物对急性缺血性卒中患者静脉溶栓的短期安全性无显著影响，不增加症状性颅内出血的发生率和在院全因死亡率。

Safety of Intravenous Thrombolysis in Acute Ischemic Stroke Patients with Antithrombotic Therapy before Stroke Onset

Objective To investigate the effect of antithrombotic therapy before stroke onset on intravenousthrombolysis in patients with acute ischemic stroke (AIS).Methods The data of in-hospital AIS patients who received intravenous thrombolysis from anational, multi-center stroke registry of from January to December, 2018 were collected andretrospectively analyzed. All the patients were divided into observation group (with antithrombotictherapy before stroke onset) and control group (without antithrombotic therapy before stroke onset).Baseline information and in-hospital safety outcomes (symptomatic intracranial hemorrhage andall-cause death) were compared between the two groups, and multivariate logistic regression wasused to analyze the correlation between pre-antithrombotic therapy and in-hospital safety outcomes.Results A total of 17 587 eligible patients in 1374 hospitals were included in this study, with 3313patients (18.8%) in observation group and 14 274 patients (81.2%) in control group. Compared tothe control group, the observation group had higher age (67.7±11.1 years vs 64.8±12.2 years), less