Sanossian N, Saver J L, Rajajee V, Selco S L, Kim D, Razinia T, Ovbiagele B
Stroke Center, Department of Neurology, UCLA Medical Center, Los Angeles, CA, USA.
Neurology. 2006 Feb 14;66(3):319-23. doi: 10.1212/01.wnl.0000195889.05792.f1. Epub 2005 Dec 28.
To evaluate the independent effect of premorbid antiplatelet use on incident ischemic stroke severity and outcome at discharge.
The authors studied consecutive patients presenting within 24 hours of ischemic stroke over a 1-year period. National Institutes of Health Stroke Scale (NIHSS) score at presentation was used as index of stroke severity and a modified Rankin scale of 0 to 1 at discharge as index of good functional outcome. Patients were categorized according to their premorbid antiplatelet use as antiplatelet-inclusive (AI) and no antiplatelet (NA). Demographic data, risk factors, pertinent laboratory tests, other medications, and stroke mechanisms were controlled for across the two groups using multivariate logistic regression.
A total of 260 individuals met study criteria: 92 patients were on antiplatelet agents prior to admission, 168 were on no antiplatelets. Pretreatment with antiplatelet was associated with lower presenting median NIHSS (4.5 vs 7, p = 0.005). Antiplatelet use was associated with less severe stroke at presentation in those having no history of stroke or TIA (4.8 vs 8.0, p = 0.03) but not in those with a prior history of stroke or TIA (4.9 vs 4.9, p = 0.987). The likelihood of a good outcome was increased in those on antiplatelets after adjusting for other variables (OR 2.105, p = 0.0073).
Prestroke use of antiplatelet may be associated with reduced severity of incident ischemic strokes in those with no prior history of stroke or TIA, and with an increased likelihood of a good discharge outcome regardless of prior cerebrovascular event history.
评估病前使用抗血小板药物对缺血性脑卒中发病时严重程度及出院时预后的独立影响。
作者研究了在1年时间内缺血性脑卒中发病24小时内连续就诊的患者。就诊时的美国国立卫生研究院卒中量表（NIHSS）评分用作卒中严重程度指标，出院时改良Rankin量表评分为0至1用作良好功能预后指标。患者根据病前抗血小板药物使用情况分为抗血小板药物使用者（AI）和未使用抗血小板药物者（NA）。通过多因素逻辑回归对两组的人口统计学数据、危险因素、相关实验室检查、其他药物及卒中机制进行控制。
共有260人符合研究标准：92例患者入院前使用抗血小板药物，168例未使用抗血小板药物。抗血小板药物预处理与就诊时较低的NIHSS中位数相关（4.5对7，p = 0.005）。在无卒中或短暂性脑缺血发作（TIA）病史的患者中，使用抗血小板药物与就诊时较轻的卒中相关（4.8对8.0，p = 0.03），但在有卒中或TIA病史的患者中并非如此（4.9对4.9，p = 0.987）。在调整其他变量后，使用抗血小板药物的患者获得良好预后的可能性增加（比值比2.105，p = 0.0073）。
在无卒中或TIA病史的患者中，卒中前使用抗血小板药物可能与降低缺血性脑卒中发病时的严重程度相关，并且无论既往脑血管事件史如何，都可能增加出院时获得良好预后结局的可能性。
