阿加曲班联合阿司匹林与替罗非班治疗进展性脑梗死的疗效与安全性分析

Efficacy and safety analysis of agatroban combined with aspirin and Tirofiban in the treatment of progressive cerebral infarction

摘要:

目的比较阿加曲班联合阿司匹林与替罗非班治疗进展性脑梗死的疗效和安全性。 方法收集2021年6月—2023年10月在南方医院增城院区住院诊治的进展性脑梗死患者101例,将收集的病例患者分为两组,A组(n=64)应用阿加曲班+阿司匹林治疗,B组(n=37)应用替罗非班治疗,记录两组患者治疗前后美国国立卫生研究院脑卒中量表（National Institutes of Health Stroke Scale, NIHSS）评分、改良Rankin量表（modified Rankin Scale, mRS）评分及巴氏指数评定量表（Barthel Index, BI）来评估患者在不同时间段的治疗效果,同时记录治疗过程中各种出血并发症来评估用药安全性。 结果在治疗大动脉粥样硬化型进展性脑梗死患者中,A组治疗后48h、7d、出院时NIHSS、30d、90d mRS较B组均有下降（P<0.05）,治疗后30d、90d BI较B组升高（P<0.05）；在治疗小血管闭塞型进展性脑梗死患者中,两组用药差异无统计学意义（P>0.05）；在治疗后循环进展性脑梗死患者中,A组出院时NHISS评分低于B组（P<0.05）；两组治疗后30d、90d mRS评分均有下降（P>0.05）,治疗后30d BI指数、90d BI指数均有上升（P>0.05）；两组用药治疗前循环进展性脑梗死差异无统计学意义（P>0.05）；两组用药治疗过程中均无严重不良反应（P>0.05）。 结论阿加曲班联合阿司匹林治疗大动脉粥样硬化型进展性脑梗死较替罗非班组效果好,两组治疗小血管闭塞性进展性脑梗死疗效相当；阿加曲班联合阿司匹林治疗后循环进展性脑梗死早期效果较替罗非班可能更好,两组治疗前循环进展性脑梗死效果相当；两组用药安全性相当,未发生严重的出血不良事件。

Abstract:

ObjectiveTo compare the efficacy and safety of agatroban plus aspirin with tirofiban in the treatment of progressive cerebral infarction. MethodsA total of 101 patients with progressive cerebral infarction admitted to Zengcheng Campus of Nanfang Hospital from June 2021 to October 2023 were enrolled, including including 64 cases treated with agatrotriban+aspirin(group A), and 37 cases treated with Tirofiban(group B) . National Institutes of Health Stroke Scale(NIHSS) score, modified Rankin Scale(mRS) score and Barthel Index(BI) were evaluated before and after treatment and bleeding complications during treatment were recorded. ResultsThe NIHSS scores at 48h, at 7d and at discharge in group A were significantly lower than those in group B(P<0.05), and the BI at 30d and 90d after treatment in group A was significantly higher than that in group B(P<0.05). For patients with small vessel occlusion there was no significant difference in the treatment efficacy between the two groups(P>0.05). For patients with progressive posterior circulation infarct the NHISS score in group A was lower than that in group B after treatment(P<0.05); the mRS scores at 30d and 90d after treatment were lower(P>0.05), and the BIs at 30d and 90 d after treatment in group A were higher than those of group B(P>0.05). For patients with progressive anterior circulation infarct there was no significant difference in treatment efficacy between the two groups(P>0.05). There were no serious adverse reactions in both groups(P>0.05). ConclusionAgatroban combined with aspirin is more effective than Tirofiban in the treatment of large artery atherosclerotic progressive cerebral infarction; while the two schemes have similar efficacy in the treatment of progressive cerebral infarction with small vessel occlusion. The early effect of agatroban combined with aspirin in the treatment of progressive posterior circulation infarct may be better than that of tirofiban, and the effect of the two groups in treatment of progressive anterior circulation infarct is similar. The drug safety of the two schemes is similar, and there are no serious adverse bleeding events in both schemes.