Stroke:阿司匹林治疗失败的缺血性卒中患者抗血栓治疗可预防卒中

2021-10-27 MedSci原创 MedSci原创

在接受阿司匹林预防性治疗的缺血性卒中患者中,近一半患者出院时使用阿司匹林单药治疗,而没有改变抗血栓药物类别,而另一半出院时使用氯吡格雷单药治疗、双联抗血小板治疗或其他不太常见的药物治疗。

许多急性缺血性卒中老年患者在入院前已经服用阿司匹林。然而,阿司匹林治疗失败患者的治疗策略尚未完全明确。

近日,血管疾病领域权威杂志Stroke上发表了一篇研究文章,研究人员使用来自美国心脏协会卒中登记处的数据来描述在卒中前服用阿司匹林并于2012年10月至2017年12月期间从美国1734家医院出院的缺血性卒中医疗保险受益人的出院抗血栓治疗模式。

在261634名缺血性卒中幸存者中,100016人(38.2%)在卒中前服用阿司匹林单药治疗。其中,44.4%的患者出院时仍接受阿司匹林单药治疗(20.9%为81mg,18.2%为325mg,5.3%为其他或未知剂量)。其次最常见的治疗选择是双重抗血小板治疗(24.6%),其次是氯吡格雷单药治疗(17.8%)。

其余13.2%的患者出院后服用阿司匹林/双嘧达莫、华法林或非维生素K拮抗剂口服抗凝剂,伴有或不伴有抗血小板治疗,或根本不进行抗血栓治疗。

由此可见,在接受阿司匹林预防性治疗的缺血性卒中患者中,近一半患者出院时使用阿司匹林单药治疗,而没有改变抗血栓药物类别,而另一半出院时使用氯吡格雷单药治疗、双联抗血小板治疗或其他不太常见的药物治疗。这些结果强调了进一步研究的必要性,以确定针对这种非常常见和复杂的临床情况的最佳治疗策略。

原始出处:

Jay B. Lusk.et al.Antithrombotic Therapy for Stroke Prevention in Patients With Ischemic Stroke With Aspirin Treatment Failure.stroke.2021.https://www.ahajournals.org/doi/10.1161/STROKEAHA.121.034622

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JAHA:急性失代偿性心衰患者缺血性卒中

在ADHF住院期间,1.6%的患者发生缺血性卒中。男性、ACS、既往心衰住院和入院时高BNP/NT-proBNP水平与缺血性卒中独立相关。

Stroke:HDL亚型与隐性脑梗塞和缺血性卒中事件的关系

高密度脂蛋白(HDL)是否与血管性脑损伤的风险相关尚未明确。HDL由许多种载脂蛋白组成,形成了不同的HDL亚型。

脑出血后何时重启抗血小板治疗?

抗血小板治疗是缺血性卒中和冠状动脉疾病一级和二级预防的基石。

Lancet Neurol:难分伯仲——非免疫原性重组葡激酶与阿尔替普酶治疗急性缺血性卒中患者的比较(FRIDA)

对于急性缺血性卒中患者,非免疫原性葡激酶的疗效不逊于阿尔替普酶。病死率、症状性颅内出血和严重不良事件在各组之间没有显著差异,其在4.5h时间窗内治疗急性缺血性卒中的安全性和有效性有待进一步研究。