缺血性中风尽管抗血小板治疗:原因和结果
Norbert Silimon1, Boudewijn Drop1, Leander Clénin1
1Department of Neurology, Stroke Research Center Bern, Inselspital University Hospital Bern and University of Bern, Bern, Switzerland.
European stroke journal
|August 25, 2023
概括
缺血性中风可以发生,尽管抗血小板治疗 (APT). 在APT治疗期间发生中风的患者面临复发性中风的更高风险,尽管结果并没有明显恶化.
科学领域:
- 神经学 神经学
- 心脏病学 心脏病学
- 公共卫生 公共卫生
背景情况:
- 缺血性中风仍然是一个重要的健康问题,即使在接受抗血小板治疗 (APT) 的患者中也是如此.
- 了解这些"突破性"中风的特征和结果对于优化患者护理和预防策略至关重要.
研究的目的:
- 研究尽管使用抗血小板治疗 (APT) 的患者中发生的缺血性中风的频率,原因和结果.
- 确定先前使用APT与不良功能结果或复发性缺血性中风之间的关联.
主要方法:
- 一项使用瑞士中风注册表 (01/2014-07/2022) 数据的队列研究,包括成像确认的缺血性中风患者.
- 评估先前的抗血小板治疗 (APT) 状态,使用修改的TOAST分类来评估中风病因,以及3个月后的结果 (功能状态,复发性中风).
- 使用回归模型分析了先前APT与不良结果的关联.
主要成果:
- 在53352名患者中,有33.3%接受APT. 在有史以来缺血性中风/TIA的患者中,55.2%接受APT.
- 尽管有APT,缺血性中风的病因是多样化的,心血管栓塞 (23.6%) 和大动脉动脉样硬化 (19.8%) 是最常见的.
- 之前的APT没有与不良的功能结果或3个月后的死亡有关,但与复发性中风的显著增加风险有关 (aOR 1.26,p < 0.001).
结论:
- 大约三分之一的缺血性中风发生在接受APT的患者中,这突显了这种治疗在某些情况下的局限性.
- 尽管有APT,但发生的中风具有异质病因,并且与随后的复发性中风的风险增加有关.
- 这些发现强调,需要在接受抗血小板治疗的患者中继续研究中风预防和治疗.
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