Nowadays,elderly people represent a growing population segment with a well known increased risk of both ischemic and bleeding events.Current acute coronary syndrome guidelines,strongly recommend dual antiplatelet ther...Nowadays,elderly people represent a growing population segment with a well known increased risk of both ischemic and bleeding events.Current acute coronary syndrome guidelines,strongly recommend dual antiplatelet therapy(DAPT)with few specific references for aged patients due to lack of evidence.Patients aged>75 years are misrepresented in the classic derivation trials cohorts.Strategies to reduce the bleeding risk in this group of patients are urgently needed for the daily clinical practice.Identify the specific age related bleeding risk factors and the importance of an integral geriatric assessment remains challenging.Some of the available in-hospital and out-hospital bleeding risk scores have shown a lower to moderate predictive ability in older patients and no specific tools are developed in elderly population.The importance of an appropriate vascular access choice,type and duration of antiplatelet drugs is crucial to reduce the bleeding risk.Increase radial approaches and short DAPT duration leads to reduce hemorrhages.One interesting subgroup of patients is those who need chronic anticoagulation therapy after percutaneous coronary intervention,due to their very high risk of bleeding.New alternatives as dual therapy with oral anticoagulation and only one antiplatlet drug should be considered.In current review,we evaluate the available evidence about bleeding risk in elderly.展开更多
目的探讨神经介入结合阿替普酶静脉溶栓治疗急性缺血性脑卒中的效果以及出血风险。方法选取2020年1月—2023年1月连云港市赣榆区人民医院收治的106例急性缺血性脑卒中患者,以随机数表法分为对照组和观察组,各53例。对照组采取神经介入...目的探讨神经介入结合阿替普酶静脉溶栓治疗急性缺血性脑卒中的效果以及出血风险。方法选取2020年1月—2023年1月连云港市赣榆区人民医院收治的106例急性缺血性脑卒中患者,以随机数表法分为对照组和观察组,各53例。对照组采取神经介入手术治疗,观察组则接受阿替普酶静脉溶栓后桥接神经介入手术治疗。对比两组血流动力学指标、神经功能缺损量表(National Institute of Health Stroke Scale,NIHSS)评分、改良Rankin量表(Modified Rankin Scale,mRS)评分及出血情况。结果治疗后,两组血流动力学指标均有所改善,且观察组改善程度优于对照组,差异有统计学意义(P<0.05)。治疗后,观察组NIHSS评分与mRS评分均低于对照组患者,差异有统计学意义(P均<0.05)。观察组出血发生率为5.66%,对照组出血发生率为9.43%,两组比较差异无统计学意义(χ^(2)=0.541,P>0.05)。结论阿替普酶静脉溶栓治疗联合神经介入治疗可明显改善急性缺血性脑卒中患者的血流动力学和神经功能缺损情况,安全性更高,治疗后出血发生率显著降低。展开更多
文摘Nowadays,elderly people represent a growing population segment with a well known increased risk of both ischemic and bleeding events.Current acute coronary syndrome guidelines,strongly recommend dual antiplatelet therapy(DAPT)with few specific references for aged patients due to lack of evidence.Patients aged>75 years are misrepresented in the classic derivation trials cohorts.Strategies to reduce the bleeding risk in this group of patients are urgently needed for the daily clinical practice.Identify the specific age related bleeding risk factors and the importance of an integral geriatric assessment remains challenging.Some of the available in-hospital and out-hospital bleeding risk scores have shown a lower to moderate predictive ability in older patients and no specific tools are developed in elderly population.The importance of an appropriate vascular access choice,type and duration of antiplatelet drugs is crucial to reduce the bleeding risk.Increase radial approaches and short DAPT duration leads to reduce hemorrhages.One interesting subgroup of patients is those who need chronic anticoagulation therapy after percutaneous coronary intervention,due to their very high risk of bleeding.New alternatives as dual therapy with oral anticoagulation and only one antiplatlet drug should be considered.In current review,we evaluate the available evidence about bleeding risk in elderly.
文摘目的探讨神经介入结合阿替普酶静脉溶栓治疗急性缺血性脑卒中的效果以及出血风险。方法选取2020年1月—2023年1月连云港市赣榆区人民医院收治的106例急性缺血性脑卒中患者,以随机数表法分为对照组和观察组,各53例。对照组采取神经介入手术治疗,观察组则接受阿替普酶静脉溶栓后桥接神经介入手术治疗。对比两组血流动力学指标、神经功能缺损量表(National Institute of Health Stroke Scale,NIHSS)评分、改良Rankin量表(Modified Rankin Scale,mRS)评分及出血情况。结果治疗后,两组血流动力学指标均有所改善,且观察组改善程度优于对照组,差异有统计学意义(P<0.05)。治疗后,观察组NIHSS评分与mRS评分均低于对照组患者,差异有统计学意义(P均<0.05)。观察组出血发生率为5.66%,对照组出血发生率为9.43%,两组比较差异无统计学意义(χ^(2)=0.541,P>0.05)。结论阿替普酶静脉溶栓治疗联合神经介入治疗可明显改善急性缺血性脑卒中患者的血流动力学和神经功能缺损情况,安全性更高,治疗后出血发生率显著降低。
