Caso Valeria, Paciaroni Maurizio, Venti Michele, Alberti Andrea, Palmerini Francesco, Milia Paolo, Billeci Antonia M R, Silvestrelli Giorgio, Biagini Sergio, Agnelli Giancarlo
Stroke Unit, Ospedale Santa Maria della Misericordia, San'Andrea delle Fratte, Perugia, Italy.
Cerebrovasc Dis. 2007;24(2-3):215-8. doi: 10.1159/000104480. Epub 2007 Jun 28.
Antiplatelet treatment remains the first choice for primary and secondary prevention of vascular diseases; even so, expected benefits may be offset by risk of bleeding, particularly cerebral hemorrhage. The aim of this study was to assess the influence of antiplatelet treatment on clinical outcome at hospital discharge.
Consecutive patients with first-ever stroke due to a primary intraparenchymal hemorrhage were prospectively identified over a 4-year period (2000-2003). Data on hemorrhage location, vascular risk factors, and antiplatelet and anticoagulant treatment were collected. At discharge, outcome was measured using the modified Rankin Scale (disabling stroke > or =3). Patients treated with anticoagulant therapy were excluded from the study.
Of 457 consecutive patients with cerebral hemorrhage, 94 (20.5%) had been taking antiplatelet agents. The treated patients (mean age for antiplatelet group 78.9 +/- 9.0 years) were older than the nontreated patients (73.8 +/- 9.4, p = 0.02). In-hospital mortality was 23.4 and 23.1% (p = n.s.) for patients who had been taking antiplatelet agents or no treatment. Poor outcome at discharge was found in 52.1 and 59.7% (p = n.s.), respectively. Univariate analysis showed that age and coma at admission were predictors of disability at discharge, but antiplatelet treatment was not. Additionally, age and coma were shown to be determinants of disability at discharge after multivariate analysis: OR 1.03 per year (95% CI: 1.018-1.049), p < 0.001 and OR 1.68 (95% CI: 1.138-2.503), p = 0.009, respectively.
Hemorrhagic stroke continues to be responsible for a high percentage of disability and death. Furthermore, it was seen here that functional outcome was independent of previous antiplatelet treatment.
抗血小板治疗仍然是血管疾病一级和二级预防的首选；即便如此，预期获益可能会被出血风险抵消，尤其是脑出血。本研究的目的是评估抗血小板治疗对出院时临床结局的影响。
前瞻性纳入在4年期间（2000 - 2003年）首次因原发性脑实质内出血导致卒中的连续患者。收集出血部位、血管危险因素以及抗血小板和抗凝治疗的数据。出院时，使用改良Rankin量表（致残性卒中≥3级）评估结局。接受抗凝治疗的患者被排除在研究之外。
在457例连续的脑出血患者中，94例（20.5%）一直在服用抗血小板药物。接受治疗的患者（抗血小板组平均年龄78.9±9.0岁）比未接受治疗的患者年龄更大（73.8±9.4岁，p = 0.02）。服用抗血小板药物或未接受治疗的患者院内死亡率分别为23.4%和23.1%（p = 无统计学差异）。出院时不良结局分别为52.1%和59.7%（p = 无统计学差异）。单因素分析显示年龄和入院时昏迷是出院时残疾的预测因素，但抗血小板治疗不是。此外，多因素分析显示年龄和昏迷是出院时残疾的决定因素：每年OR为1.03（95%CI：1.018 - 1.049），p < 0.001；OR为1.68（95%CI：1.138 - 2.503），p = 0.009。
出血性卒中仍然导致高比例的残疾和死亡。此外，在此研究中发现功能结局与先前的抗血小板治疗无关。
