摘要
目的报道国内首例服用达比加群抗凝的急性缺血性卒中患者予以依达赛珠单抗拮抗后行重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓病例。同时对国外已报道的病例进行数据汇总及分析。方法对于2019年11月1日在北京友谊医院就诊的国内首例服用达比加群抗凝的急性缺血性卒中患者,使用依达赛珠单抗拮抗后行rt-PA静脉溶栓病例资料进行总结。并将本病例与全球范围内已报道的18例病例资料进行文献汇总及数据分析。结果19例病例分析显示,患者平均年龄为(73.1±8.1)岁,高于其他中国缺血性卒中亚型(CISS)分型患者。国际标准化比值(INR)平均值为1.19±0.14,活化部分凝血活酶时间(APTT)均值为(41.1±15.6)s,高于正常值。16例患者治疗后症状较前改善,预后较好。患者溶栓前的美国国立卫生院卒中量表(NIHSS)评分从治疗前的平均(11.58±7.97)分降至平均(4.59±5.24)分,总体获益率与普通静脉溶栓人群相当。但入院到开始溶栓时间(DNT)时间因拮抗剂的使用延长至平均138 min。结论服用达比加群抗凝中出现急性缺血性脑卒中的患者,予以依达赛珠单抗逆转后进行rt-PA溶栓治疗是安全有效的。
Objective To report the first case of intravenous thrombolysis with recombinant tissue-type plasminogen activator(rt-PA)in a patient with acute ischemic stroke who received anticoagulant treatment with dapigatran in China.At the same time,the data of reported cases abroad were summarized and analyzed.Methods The data of the first case of acute ischemic stroke patient who received dabigatran anticoagulant in Beijing Friendship Hospital on November 1,2019 and underwent rt-PA intravenous thrombolysis after receiving edasezumab antagonism were summarized.Literature review and data analysis were performed on this case and other 18 cases reported worldwide.Results The mean age of the 19 patients were 73.1±8.1 years,which were higher than that of other(Chinese Ischemic Stroke Subclassification,CISS)patients.The average INR was 1.19±0.14.The average value of APTT was(41.1±15.6)s,which was higher than the normal range.The symptoms of 16 patients improved after treatment and the prognosis was better.The average score of NIHSS decreased from(11.58±7.97)scores to(4.59±5.24)score before treatment,and the overall benefit rate was comparable to that of the general intravenous thrombolysis population.However,the DNT was extended to an average of 138 minutes due to the use of antagonists.Conclusion Rt-PA thrombolytic therapy after edasezumab reversal is safe and effective for patients with acute ischemic stroke who was using anticoagulation treatment with dabigatran.
作者
谢聃
王学凡
甄祯
张拥波
XIE Dan;WANG Xue-fan;ZHEN Zhen(.Department of Neurology,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China.)
出处
《临床和实验医学杂志》
2021年第17期1898-1902,共5页
Journal of Clinical and Experimental Medicine
关键词
急性缺血性卒中
达比加群
依达赛珠单抗
抗凝
静脉溶栓
Acute ischemic stroke
Dabigatran
Idacelizumab
Anticoagulation
Intravenous thrombolysis
