对于无症状的动脉狭窄症的药理干预措施
Caroline Nb Clezar1, Carolina Dq Flumignan1, Nicolle Cassola1
1Department of Surgery, Division of Vascular and Endovascular Surgery, Universidade Federal de São Paulo, São Paulo, Brazil.
The Cochrane database of systematic reviews
|August 11, 2023
概括
无症状动脉狭窄症的药理疗法在预防中风或死亡方面显示出有限的益处证据. 需要高质量的试验来确定这种情况的有效医疗治疗方法.
科学领域:
- 心血管医学 心血管医学
- 神经学 神经学
- 临床药理学 临床药理学
背景情况:
- 动脉狭窄,这是由于动脉样硬化而导致的动脉狭窄,造成缺血性中风的重大风险,特别是在老年男性中.
- 无症状的动脉狭窄发生在没有先前症状的情况下,使得中风成为第一个表现,突出显示了严重的公共卫生问题.
- 动脉样硬化的危险因素包括糖尿病,高血压,高脂血症和吸烟,有助于大脑动脉狭窄的流行.
研究的目的:
- 评估药理干预措施在预防无症状大脑管狭窄症患者的神经损伤和中风方面的有效性.
- 评估这些治疗对死亡率,严重出血和其他不良事件的影响.
- 综合来自随机对照试验 (RCT) 关于各种药物类别有效性的证据.
主要方法:
- 对34项涉及11,571名参与者的RCT进行了系统审查和元分析.
- 来自22项研究 (6887名参与者) 的数据被用于元分析,平均随访时间为2.5年.
- 干预措施包括抗血小板剂,抗高血压剂,抗凝固剂和降脂剂,与安慰剂或没有治疗相比.
主要成果:
- 低确定性证据表明,抗血小板药物 (阿司匹林) 和抗高血压药物 (美托普罗罗尔) 对中风或死亡率几乎没有影响.
- 甲显示有潜力减缓动脉狭窄的进展,而华法林对主要出血的影响尚不确定,但可能会减少不良事件.
- 与安慰剂或不接受治疗相比,降脂剂在中风,死亡率或不良事件中几乎没有差异.
结论:
- 目前从高质量的RCT中获得的证据支持无症状大脑管狭窄症的药理干预是有限的.
- 需要进一步进行严格的研究,以确定最佳的医疗治疗方法,以减少动脉狭窄的负担,并预防缺血事件.
- 临床医生目前依靠其他信息来源做出治疗决策,因为没有明确的证据.
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