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首页> 外文期刊>Journal of stroke and cerebrovascular diseases: The official journal of National Stroke Association >Low Molecular Weight Heparin Versus Aspirin for Acute Ischemic Stroke: A Systematic Review
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Low Molecular Weight Heparin Versus Aspirin for Acute Ischemic Stroke: A Systematic Review

机译：低分子量肝素与阿司匹林治疗急性缺血性卒中的系统评价

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Aspirin is the standard treatment for acute ischemic stroke, although heparins are widely prescribed. We performed a systematic review of randomized controlled trials to compare the safety and efficacy of low molecular weight heparins (LMWH) with aspirin in acute ischemic stroke. Two completed randomized controlled trials involving 1,933 patients were identified; 1 trial only included patients with presumed cardioembolic stroke. As compared with aspirin, treatment with heparin was associated with a significant reduction in symptomatic venous thromboembo-lism (odds ratio [OR] - 0.29,95% confidence interval [CI] - 0.12-0.66) and an increase in major extracranial hemorrhage (OR - 2.57, 95% CI - 1.01-6.52). Nonsignificant increases in end-of-treatment case fatality (OR - 1.35, 95% CI - 0.87-2.08) and symptomatic intracranial haemorrhage (OR - 1.82, 95% CI - 0.68-4.87) were seen; symptomatic intracranial haemorrhage was significantly raised (OR - 4.26, 95% CI -1.04-17.4) with heparin in patients treated within 24 hours of stroke onset. Stroke recurrence (OR - 1.24, 95% CI - 0.79-1.94) and deterioration (OR - 1.13, 95% CI -0.85-1.50) during treatment and end-of-trial death (OR - 1.00, 95% CI - 0.77-1.30) or dependency and case fatality (OR - 1.03, 95% CI - 0.85-1.25) did not differ between the 2 treatments. No benefit of LMWH over aspirin was seen in patients with presumed cardioembolic stroke. Low molecular weight heparin should not replace aspirin in the routine management of patients with ischemic stroke, including those with presumed cardioembolic stroke.
机译：阿司匹林是急性缺血性中风的标准治疗方法，尽管肝素已被广泛处方。我们对随机对照试验进行了系统评价，以比较低分子量肝素（LMWH）和阿司匹林在急性缺血性卒中中的安全性和有效性。确定了两项涉及1,933名患者的完整随机对照试验;一项试验仅包括假定的心脏栓塞性卒中患者。与阿司匹林相比，肝素治疗可显着减少症状性静脉血栓栓塞症（几率[OR]-0.29,95％置信区间[CI]-0.12-0.66）和严重颅外出血（OR） -2.57，95％CI-1.01-6.52）。观察到治疗结束时病死率（OR-1.35，95％CI-0.87-2.08）和有症状的颅内出血（OR-1.82，95％CI-0.68-4.87）无明显增加;在卒中发作后24小时内接受肝素治疗的患者，症状性颅内出血明显升高（OR-4.26，95％CI -1.04-17.4）。治疗期间和试验终末期卒中复发（OR-1.24，95％CI-0.79-1.94）和恶化（OR-1.13，95％CI -0.85-1.50）（OR-1.00，95％CI-0.77- 1.30）或依赖性和病死率（OR-1.03，95％CI-0.85-1.25）在两种治疗之间没有差异。在假定的心脏栓塞性卒中患者中，LMWH没有优于阿司匹林的益处。低分子量肝素在缺血性中风患者（包括假定的心脏栓塞性中风）的常规治疗中不应替代阿司匹林。

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