急性缺血性卒中阿替普酶静脉溶栓后早期抗栓治疗安全性和有效性的荟萃分析 Meta-analysis of Safety and Efficacy of Early Antithrombotic Therapy in Patients with Acute Ischemic Stroke after Intravenous Alteplase Thrombolysis
摘要
目的 探索急性缺血性卒中患者接受阿替普酶静脉溶栓后24 h内给予抗栓治疗的安全性和有效性。 方法 利用计算机检索PubMed、Cochrane Library、EMbase和Web of Science数据库，查找关于阿替普酶 静脉溶栓后早期抗栓（24 h内）与标准抗栓（24 h后）治疗急性缺血性卒中疗效对比的随机对照试验、 匹配对照和非随机对照研究，检索时限均为从建库至2017年10月。由2位评价者按照纳入与排除标 准独立筛选文献、提取资料后，采用Stata 14.0软件进行荟萃分析，从而比较溶栓后早期抗栓与标准 抗栓治疗发生症状性脑出血、90 d死亡和良好预后差异。 结果 最终纳入11项研究（包括4项随机对照试验、2项匹配对照和5项非随机对照研究），共计2082 例患者，早期抗栓组有1219例（58.5%），标准抗栓组有863例（41.5%）。荟萃分析结果显示：与标 准抗栓组相比，接受早期抗栓的患者90 d良好预后的比例更高[比值比（odds ratio，OR）1.41，95%可 信区间（confidence interval，CI）1.15～1.73，P =0.001）]，而两组患者的症状性脑出血发生率（OR 1.08， 95%CI 0.63～1.86，P =0.78）和90 d死亡率（OR 1.13，95%CI 0.81～1.57，P =0.48）无显著性差异。 结论 与标准抗栓相比，急性缺血性卒中患者在接受阿替普酶静脉溶栓后24 h内给予早期抗栓治 疗的90 d功能预后更好，并且不会增加症状性脑出血和死亡风险。 Abstract: Objective To explore the safety and efficacy of antithrombotic therapy in patients with acute ischemic stroke (AIS) in 24 hours after receiving intravenous alteplase thrombolytic therapy. Methods Literature search was carried out in PubMed, Cochrane Library (as of the 10th issue of 2017), EM base and Web of Science data base up to October 2017, for cohort studies on curative effect observation of comparing early antithrombotic therapy (within 24 h) with standard antithrombotic therapy (after 24 h) after altipase thrombolysis in AIS patients in randomized controlled trials, matched controlled trials and non-randomized controlled trials. According to inclusion and exclusion criteria, two reviewers independently screened literature, extracted data, and assessed methodological quality of included studies. Then meta-analysis was performed by using Stata 14.0, to compare the 90-day favorable outcome and mortality, and symptomatic intracranial hemorrhage (sICH) between the two groups. Results A total of 11 cohort studies (including 4 randomized controlled trials, 2 matched controlled trials and 5 non-randomized controlled trials) were finally included involving 2082 cases. The early antithrombotic group had 1219 cases (58.5%) and standard antithrombotic group had 863 cases (41.5%). The results of meta-an