Association of Profylactic Use of Stress Ulcus Drugs og kliniske resultater hos pasienter med akutt fremre sirkulasjonstrombektomi
Association of Profylactic Use of Stress Ulcus Drugs and Clinical Outcomes in Patients With Acute Anterior Circulation Thrombeectomy: a Prospective, Multicenter, Observational Cohort Study
Ischemic stroke accounts for a relatively high proportion of strokes. In recent years, intravenous thrombolysis and endovascular therapy have significantly improved the revascularization rate in patients with large vessel occlusive cerebral infarction, but 20-50% of patients still experience ineffective revascularization. Therefore, postoperative monitoring and treatment of patients with large vessel occlusions is crucial for early recognition, management and prevention of complications. Stress ulcer bleeding is a serious complication after acute ischemic stroke, with a prevalence of 1%-5%, and a previously proven incidence of stress ulcer bleeding after ischemic stroke. Stress ulcer bleeding after ischemic stroke has been shown to be closely associated with unfavorable outcomes, such as mortality. Current national and international guidelines or consensus on the prevention of stress ulcers after acute ischemic stroke do not advocate the routine use of histamine receptor antagonists or proton pump inhibitors for the prevention of stress ulcers, but rather should be considered in the context of the patient's risk factors for stress ulcers and discontinued after the patient initiates enteral nutrition. However, there is no evidence-based medical evidence to support the risk-benefit relationship of stress ulcer drug prophylaxis in patients with mechanical thrombectomy for acute anterior circulation large vessel occlusion.
Studieoversikt
Status
Forhold
Detaljert beskrivelse
Stress ulcer bleeding is a serious complication after acute ischemic stroke, with a prevalence of 1%-5%, of which only 0.5%-1% require blood transfusion or result in hypotension. Stress ulcer bleeding after ischemic stroke has been shown to be associated with poor outcomes, such as mortality, and basilar artery occlusion and middle cerebral artery cerebral infarction are independent risk factors for stress ulcer bleeding after acute ischemic stroke. Guidelines or consensus on the prevention of stress ulcers after acute ischemic stroke do not advocate the routine use of histamine receptor antagonists or proton pump inhibitors for stress ulcer prevention.
However, stress ulcer prophylaxis is initiated in most patients admitted to the neurological intensive care unit after mechanical embolization of acute anterior circulation large vessel occlusion. With advances such as diagnosis and early initiation of enteral nutrition, the rate of stress ulcer bleeding in patients with mechanical embolization of acute anterior circulation large vessel occlusion is significantly reduced. The relationship between the risk and benefit of SUP in patients undergoing mechanical embolization for acute anterior circulation large vessel occlusion is not yet supported by evidence-based medical evidence. Therefore, the purpose of this study was to investigate the correlation between pharmacological stress ulcer prophylaxis and clinical outcomes in patients undergoing mechanical thrombectomy for acute anterior circulation large vessel occlusion.
Studietype
Registrering (Antatt)
Kontakter og plasseringer
Studiekontakt
- Navn: Suyue Pan, M.D., Ph.D.
- Telefonnummer: 13556184981
- E-post: pansuyue@smu.edu.cn
Studiesteder
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Fujian
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Fuzhou, Fujian, Kina
- Rekruttering
- Fujian Medical University Union Hospital
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Ta kontakt med:
- Shenggen Chen, M.D.
- Telefonnummer: 13459480275
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Guangdong
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Dongguan, Guangdong, Kina
- Rekruttering
- Dongguan People's Hospital
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Ta kontakt med:
- Zhu Shi, M.D.
- Telefonnummer: 13669825459
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Dongguan, Guangdong, Kina
- Rekruttering
- Dongguan donghua hospital
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Ta kontakt med:
- Lingyu Sun
- Telefonnummer: 13829203368
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Guangzhou, Guangdong, Kina
- Rekruttering
- Nanfang Hospital of Southern Medical University
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Ta kontakt med:
- Suyue Pan
- Telefonnummer: 13556184981
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Guangzhou, Guangdong, Kina
- Rekruttering
- Guangdong Provincial Hospital of Traditional Chinese Medicine
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Ta kontakt med:
- Lixin Wang, M.D.
- Telefonnummer: 13922793886
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Guangzhou, Guangdong, Kina
- Rekruttering
- Huadu District People's Hospital of Guangzhou
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Ta kontakt med:
- Guangning Li, M.D.
- Telefonnummer: 13926239656
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Guangzhou, Guangdong, Kina
- Rekruttering
- The Fourth Affiliated Hospital of Guangzhou Medical University
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Ta kontakt med:
- Wangchi Luo, M.D.
- Telefonnummer: 13710895142
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Heyuan, Guangdong, Kina
- Rekruttering
- Heyuan people's Hospital
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Ta kontakt med:
- Minzhen Zhu
- Telefonnummer: 15007622318
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Huizhou, Guangdong, Kina
- Rekruttering
- Huizhou Municipal Central Hospital
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Ta kontakt med:
- Lizhi Wang, M.D.
- Telefonnummer: 13802872076
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Hainan
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Haikou, Hainan, Kina
- Rekruttering
- Hainan Provincial People's Hospital
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Ta kontakt med:
- Fan Zhang, M.D.
- Telefonnummer: 17389897580
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Haikou, Hainan, Kina
- Rekruttering
- Haikou People's Hospital
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Ta kontakt med:
- Guoshuai Yang, M.D.
- Telefonnummer: 13876006248
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Haikou, Hainan, Kina
- Rekruttering
- Hainan Traditional Chinese Medicine Hospital
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Ta kontakt med:
- Yong Gu, M.D.
- Telefonnummer: 15521280288
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Hunan
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Changsha, Hunan, Kina
- Rekruttering
- The First Hospital of Changsha
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Ta kontakt med:
- Xu Peng, M.D。
- Telefonnummer: 15802507292
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Hengyang, Hunan, Kina
- Rekruttering
- The Second Hospital University of South China
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Ta kontakt med:
- Yanhong Hu, M.D.
- Telefonnummer: 13265004191
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Yueyang, Hunan, Kina
- Rekruttering
- Yueyang People's Hospital
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Ta kontakt med:
- Yuan Zhou, M.D.
- Telefonnummer: 15107309796
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Inner Mongolia
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Baotou, Inner Mongolia, Kina
- Rekruttering
- Sinopharm North Hospital
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Ta kontakt med:
- Lifei Xing, M.D
- Telefonnummer: 15354919958
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Hohhot, Inner Mongolia, Kina
- Rekruttering
- The Affiliated Hospital of Inner Mongolia Medical University
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Ta kontakt med:
- Lihua Sun, M.D.
- Telefonnummer: 18686292585
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Jiangxi
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Ganzhou, Jiangxi, Kina
- Rekruttering
- Ganzhou City People's Hospital
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Ta kontakt med:
- Zhaohui Lai
- Telefonnummer: 13879729792
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Zhejiang
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Wenzhou, Zhejiang, Kina
- Rekruttering
- Second Affiliated Hospital of Wenzhou Medical University
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Ta kontakt med:
- Saijun Zhou, M.D.
- Telefonnummer: 13857746659
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Deltakelseskriterier
Kvalifikasjonskriterier
Alder som er kvalifisert for studier
Tar imot friske frivillige
Kjønn som er kvalifisert for studier
Prøvetakingsmetode
Studiepopulasjon
Patients who are treated with mechanical thrombectomy with acute anterior circulation large vessel occlusion. ≥18 years of age, within 24 hours of onset. Expected survival >3 months. NIHSS score ≥ 6 at onset of illness.
Beskrivelse
Inclusion Criteria:
- Age ≥18 years.
- Within 24 hours of onset. Meet the criteria for diagnosis of acute ischemic stroke in the "China Acute Ischemic Stroke Diagnosis and Treatment Guidelines 2018".
- Meet the indications for mechanical thrombectomy in the "Chinese Guidelines for Early Endovascular Interventions in Acute Ischemic Stroke 2022".
- Treated with mechanical thrombectomy.
- NIHSS score ≥ 6 at onset of illness.
- Sign an informed notice.
Exclusion Criteria:
Allergy to drug ingredients. Women who are pregnant or breastfeeding. Life expectancy of less than 3 months due to other non-ischemic stroke diseases such as malignancy, severe liver or renal failure.
Have participated in other interventional clinical studies (affecting the outcome of this cohort study).
Participants who were judged by the investigator to be unsuitable for participation in this study.
Studieplan
Hvordan er studiet utformet?
Designdetaljer
- Observasjonsmodeller: COHORT
- Tidsperspektiver: PROSPECTIVE
Kohorter og intervensjoner
Gruppe / Kohort |
|---|
|
Stress Ulcer Prophylaxis
Subjects are on stress ulcer medications including PPIs, H2RBs, and mucosal protectors at 24 h of admission. |
|
Control Group
Subjects are not on stress ulcer medications including PPIs, H2RBs, and mucosal protectors at 24 h of admission. |
Hva måler studien?
Primære resultatmål
Resultatmål |
Tiltaksbeskrivelse |
Tidsramme |
|---|---|---|
|
90-day mortality after onset
Tidsramme: 90-day after onset
|
Proportion of enrolled patients who died 90 days after onset of disease. |
90-day after onset
|
|
Incidence of stroke-associated pneumonia
Tidsramme: within 7-day of onset
|
Incidence of non-mechanically ventilated stroke patients with new pneumonia within 7-day of onset |
within 7-day of onset
|
Sekundære resultatmål
Resultatmål |
Tiltaksbeskrivelse |
Tidsramme |
|---|---|---|
|
Incidence of clinically significant bleeding
Tidsramme: within 7-day of onset
|
One of the following 4 symptoms occurs within 24 hours of bleeding from a stress ulcer (in the absence of other causes):1. A decrease of ≥ 20 mmHg in any one of systolic, diastolic and mean arterial pressure. 2.Initiation of blood pressure boosters or 20% increase in medication dose.3. Decreased hemoglobin ≥ 2 g/d(（1.24 mmol/l). 4.Infusion of erythrocytes ≥ 2 U. |
within 7-day of onset
|
|
Incidence of stress ulcer bleeding
Tidsramme: 7-day after onset
|
Coffee-like residue/black stool/blood in stool within 7-day after onset and more than 2 consecutive positive fecal/gastric fluid occult blood |
7-day after onset
|
|
Incidence of unfavorable functional prognosis at 90 days after onset
Tidsramme: 90-day after onset
|
Incidence of unfavorable functional prognosis at 90 days after onset |
90-day after onset
|
|
90-day mRS score change
Tidsramme: 90-day after onset
|
Modified Rankin Scale score change within 90 days after onset in patients who were eligible for inclusion criteria |
90-day after onset
|
|
Incidence of early neurological deterioration
Tidsramme: within 72 hours after onset
|
Increased score of National Institutes of Health Stroke Scale within 72h after onset ≥ 4 |
within 72 hours after onset
|
|
1-year post-onset mortality
Tidsramme: 1 year after onset
|
Mortality at 1 year after onset in patients who were eligible for inclusion criteria |
1 year after onset
|
|
Incidence of adverse related events such as pneumonia or myocardial ischemia 1 year after onset
Tidsramme: 1 year after onset
|
Incidence of adverse related events such as pneumonia or myocardial ischemia 1 year after onset in patients who were eligible for inclusion criteria |
1 year after onset
|
Samarbeidspartnere og etterforskere
Samarbeidspartnere
Etterforskere
- Hovedetterforsker: Suyue Pan, Department of Neurology, Nanfang Hospital,Southern Medical University
Studierekorddatoer
Studer hoveddatoer
Studiestart (Faktiske)
Primær fullføring (Faktiske)
Studiet fullført (Antatt)
Datoer for studieregistrering
Først innsendt
Først innsendt som oppfylte QC-kriteriene
Først lagt ut (Faktiske)
Oppdateringer av studieposter
Sist oppdatering lagt ut (Faktiske)
Siste oppdatering sendt inn som oppfylte QC-kriteriene
Sist bekreftet
Mer informasjon
Begreper knyttet til denne studien
Ytterligere relevante MeSH-vilkår
Andre studie-ID-numre
- NFEC-2023-040
Legemiddel- og utstyrsinformasjon, studiedokumenter
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