梅斯医学MedSci APP
医路相伴,成就大医

Stroke:除了降低卒中复发,双抗还能减轻残疾

Tags: 脑卒中  DAPT  TIA  更新:2020-5-11

TIA 和小卒中早期使用阿司匹林能够降低卒中复发的风险和卒中复发的严重程度。对于这类患者,阿司匹林联合氯吡格雷双抗治疗(DAPT)比单独使用阿司匹林进一步降低了卒中复发的风险。不过,人们很少关注这种治疗对功能残疾和卒中严重程度的影响。复发性卒中是TIA和小卒中后残疾的主要原因,因此降低这种风险的治疗方法预计也会降低残疾风险。然而,许多其他因素也会导致TIA和小卒中后的残疾,如出血事件、内科并发症,以及一些小卒中发病时存在神经功能缺损。

2020年3月来自美国的 Brett Cucchiara 等在 Stroke 上公布了他们的研究结果,他们利用 POINT 试验的数据,分析了 DAPT 对残疾的影响。

POINT 试验把发病12h 内的 TIA 或小卒中(NIHSS<=3)的患者随机给予阿司匹林+氯吡格雷的 DAPT 或单独阿司匹林。主要复合终点为卒中、心梗或血管性死亡。本次作者进行了一次探索性事后分析,验讫治疗措施对90天残疾(定义为 mRS >1)的作用。

在90天时,TIA 的患者中9.6%存在残疾,小卒中的患者中18.2%存在残疾。DAPT 组和单独阿司匹林组的总残疾率相似(14.7% vs 14.3%;OR,0.97 95% CI 0.82 - 1.14,P = 0.69)。然而,在发生了主要终点事件的患者中, DAPT 组残疾的比例低于单独阿司匹林组(3% vs 4%;OR,0.73 [95% CI,0.53 - 1.01];P = 0.06);在残疾归因于 Index 事件或复发性卒中的患者中,DAPT 组残疾的比例低于单独阿司匹林组(5.9% vs 7.4%; OR, 0.78 [95% CI, 0.62 – 0.99]; P=0.04)。值得注意的是,归因于 Index 事件的残疾占了这一差异的大部分(4.5% vs 6.0%; OR, 0.74 [95% CI, 0.57–0.96]; P=0.02)。在多因素分析中,年龄、随后的缺血性卒中、女性、高血压和大出血明显与 TIA 后残疾有关;对于卒中患者,女性、高血压、糖尿病、NIHSS、复发性缺血性卒中、随后的心肌梗塞以及严重不良事件与残疾有关。

最终作者认为除了减少急性小卒中和TIA患者的复发性卒中外,DAPT还可能减少卒中相关的残疾。

原始出处:Brett Cucchiara , Jordan Elm, J. Donald Easton, et al. Disability After Minor Stroke and Transient Ischemic Attack in the POINT Trial. Stroke. 2020 Mar;

作者:杨中华    来源:脑血管病及重症文献导读 
精彩评论:
一天没事干于 2020-5-11 评论道:
很好的学习机会
(来自:MedSci医学APP)
222.175.103.101于 2020-5-11 评论道:
[精华]Despite the availability of population-based cancer survival data from the developed and developing countries, comparisons remain very few. Such comparisons are important to assess the magnitude of survival discrepancies and to disentangle the impact of ethnic background and health care access on cancer survival. Using the SEER 13 database and databases from the Manila and Rizal Cancer Registries in the Philippines, a 5-year relative survival for 9 common cancers in 1998-2002 of Filipino-American cancer patients were compared with both cancer patients from the Philippines, having the same ethnicity, and Caucasians in the United States, being exposed to a similar societal environment and the same health care system. Survival estimates were much higher for the Filipino-Americans than the Philippine resident population, with particularly large differences (more than 20-30% units) for cancers with good prognosis if diagnosed and treated early (colorectal, breast and cervix), or those with expensive treatment regimens (leukaemias). Filipino-Americans and Caucasians showed very similar survival for all cancer sites except stomach cancer (30.7 vs 23.2%) and leukaemias (37.8 vs 48.4%). The very large differences in the survival estimates of Filipino-Americans and the Philippine resident population highlight the importance of the access to and utilisation of diagnostic and therapeutic facilities in developing countries. Survival differences in stomach cancer and leukaemia between Filipino-Americans and Caucasians in the United States most likely reflect biological factors rather than the differences in access to health care.

相关推荐