在急性脑性缺血中使用立即或延迟强度的他:INSPIRES随机临床试验
Ying Gao1, Lingling Jiang2, Yuesong Pan1,2
1Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
JAMA neurology
|May 28, 2024
概括
在患有轻度缺血性中风或动脉样硬化TIA的患者中,立即强化他类药物治疗没有降低复发性中风风险. 然而,它可能会改善功能结果,而不会增加出血风险,而与延迟使用他类药物相比.
科学领域:
- 神经学 神经学
- 心血管医学 心血管医学
- 临床试验 临床试验
背景情况:
- 在二次中风预防和神经保护中,立即与延迟密集型他类药物治疗之间存在有限的比较.
- 动脉样硬化是急性轻度缺血性中风和短暂缺血性发作 (TIA) 的重要原因.
- 优化他类药物治疗时间对于治疗急性脑血管事件的患者至关重要.
研究的目的:
- 评估立即密集型他类药物治疗与延迟密集型他类药物治疗的安全性和有效性.
- 为了确定急性轻度缺血性中风或由于动脉样硬化的高风险TIA患者的复发性中风风险的影响.
- 评估与不同类型他类药物启动时间相关的神经保护作用和功能结果.
主要方法:
- 针对高风险内或外动脉样硬化 (INSPIRES) 的强化他和抗血小板治疗试验是一项双盲,安慰剂控制,随机的临床试验.
- 在发病后72小时内注册了6100名35-80岁的轻度缺血性中风或高风险的动脉样硬化TIA患者.
- 患者接受了即时密集型阿托瓦斯塔丁 (80mg 1-21天) 或3天的延迟密集型阿托瓦斯塔丁治疗方案.
主要成果:
- 90天内发生的新中风发生在即时密集组的8.1%,延迟组的8.4% (HR,0.95;95%CI,0.80-1.13).
- 在即时密集型组的9.8%观察到功能性结局较差,而延迟型组的11.4% (OR,0.83;95% CI,0.71-0.98).
- 中度至重度出血发生在即时密集型组的0.8%,延迟型组的0.6%.
结论:
- 在72小时内立即强化使用他类药物并没有显著降低该患者群体中复发性中风的风险.
- 这些发现表明,在立即密集型他类药物治疗下,改善功能结果的潜在益处.
- 在立即和延迟开始使用他类药物组之间,中度至重度出血事件没有显著差异.
相关概念视频
01:30Acute Coronary Syndrome I: Introduction
2.1K
Acute Coronary Syndrome (ACS) encompasses a spectrum of heart conditions caused by sudden obstruction of coronary arteries, typically resulting from the rupture of an atherosclerotic plaque and subsequent thrombus (blood clot) formation. This obstruction can lead to partial or complete blockage of blood flow, causing varying degrees of myocardial ischemia or infarction.ACS includes the following clinical entities:Unstable Angina (UA)Non-ST-Elevation Myocardial Infarction (NSTEMI)ST-Elevation...
2.1K
01:30Acute Coronary Syndrome III: Diagnostic Studies
495
Diagnosing acute coronary syndrome or ACS begins with a thorough patient history. Notable symptoms include central, crushing chest pain radiating to the left arm, neck, jaw, or back, along with shortness of breath, sweating (diaphoresis), nausea, vomiting, dizziness, and palpitations.It is crucial to note any history of cardiac illnesses and assess risk factors, including age, gender, smoking, hypertension, diabetes, hyperlipidemia, and a sedentary lifestyle.During physical examination, vital...
495
01:28Acute Coronary Syndrome IV: Interprofessional Care
522
IntroductionThe management of Acute Coronary Syndrome (ACS) aims to minimize myocardial damage, preserve myocardial function, and prevent complications.Initial ManagementInpatient management involves continuous cardiac monitoring, preferably in an ICU, focusing on blood pressure, serum sodium, potassium, and creatinine levels, and urine output. Ongoing pharmacologic management is crucial for stabilizing the patient.Supplemental Oxygen: Administer supplemental oxygen if oxygen saturation is...
522
01:15Ischemic Stroke l: Introduction
44
Ischemic stroke is an acute cerebrovascular condition in which blood flow to a brain region is suddenly interrupted, leading to tissue infarction. Neurons depend on continuous oxygen and glucose supply, so even brief reductions in perfusion cause energy failure, ionic imbalance, and irreversible injury. Ischemic strokes are classified into thrombotic and embolic types based on their underlying mechanisms.Thrombotic MechanismsThrombotic stroke develops when a clot forms within a cerebral artery.
44
01:15Ischemic Stroke ll: Pathophysiology
54
An ischemic stroke occurs when a cerebral blood vessel becomes obstructed, most often by a thrombus or embolus, interrupting the delivery of oxygen and glucose to brain tissue. Because neurons rely on continuous aerobic metabolism, energy failure begins within minutes of reduced perfusion. The region receiving the least blood flow becomes the infarct core, an area of irreversible cellular death. Surrounding this core lies the penumbra, a zone of hypoperfused but still viable tissue that is...
54
01:26Transient Ischemic Attack l: Introduction
18
A transient ischemic attack (TIA) is a brief episode of neurological dysfunction caused by a temporary, focal reduction in cerebral blood flow. Although symptoms resemble those of an ischemic stroke, the interruption in perfusion is short-lived and does not cause permanent infarction. TIAs are clinically important because they often serve as early warning events for future stroke.Mechanisms of Transient Cerebral IschemiaTransient cerebral ischemia may arise through several mechanisms. One...
18