Stroke:西洛他唑与阿司匹林对缺血性卒中高危脑出血患者的疗效比较

2019-12-23 xing.T MedSci原创

由此可见,西洛他唑对存在多种脑微出血且在白质广泛变化之前的缺血性卒中患者可能更有益。

尽管西洛他唑的出血事件少于阿司匹林,但在脑出血高风险患者中,出血性卒中事件仅观察到细微的差异。为了确定最能从西洛他唑治疗中获益的患者,近日,心血管疾病领域权威杂志Stroke上发表了一篇研究文章,该研究分析了PICASSO(脑出血高风险亚洲缺血性卒中患者的心血管事件预防)试验治疗与亚组之间的相互作用。

既往有脑出血或多次微出血的缺血性卒中患者被随机分配接受西洛他唑或阿司匹林治疗,平均随访1.8年。在两组中分析了疗效(定义为任何卒中、心肌梗塞和血管死亡的综合事件)和安全性(定义为出血性卒中的发生率)。研究人员分析了治疗与年龄、性别、高血压糖尿病的情况、高危脑出血指数以及白质病变负担之间的相互作用,以评估主要和次要结局。比较两组的生命体征变化和实验室检查结果。

在所有纳入的1534名患者中,观察到治疗组与出血性脑卒中患者脑出血高风险指数之间存在显著的相互作用(相互作用P为0.03)。多发性微出血患者中,西洛他唑组的出血性卒中发生率低于阿司匹林组(1 vs. 13次事件;风险比为0.08[95%CI为0.01-0.61];P=0.01)。研究人员观察到任何卒中治疗组和白质变化之间微弱的相互作用(相互作用P=0.08)。西洛他唑可降低(5例 vs. 16例事件;风险比为0.36 [95%CI为0.13-0.97]; P=0.04)至中度(16例 vs. 32例;风险比为0.50 [95%CI为0.29-0.92];P=0.03)白质变化患者的卒中风险。随访时,西洛他唑组的心率和HDL(高密度脂蛋白)胆固醇水平显著高于阿司匹林组。

由此可见,西洛他唑对存在多种脑微出血且在白质广泛变化之前的缺血性卒中患者可能更有益。

原始出处:

Bum Joon Kim.et al.Cilostazol Versus Aspirin in Ischemic Stroke Patients With High-Risk Cerebral Hemorrhage Subgroup Analysis of the PICASSO Trial.stroke.2019.https://www.ahajournals.org/doi/10.1161/STROKEAHA.119.023855

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    2019-12-24 天地飞扬

    学习

    0

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    2019-12-24 健健

    卒中虽然是临床上常见病,溶栓,取栓等血管内治疗也很成熟,但是仍然有很多未知问题有待认知!

    0

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    2019-12-24 内科新手

    谢谢梅斯提供这么好的信息,学到很多

    0

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