Kappelle L J
Universitair Medisch Centrum Utrecht, afd. Neurologie, Huispost G03.228, Postbus 85.500, 3508 GA Utrecht.
Ned Tijdschr Geneeskd. 2007 Dec 15;151(50):2761-3.
Numerous clinical trials have shown the efficacy of stroke prevention in patients with transient ischaemic attacks (TIAs) using surgical (carotid endarterectomy) or medical treatment (antiplatelet agents, antihypertensive drugs and statins). In all of these studies, however, the interval between the ischaemic event and treatment was weeks or months. The recently published EXPRESS study from Oxford showed that stroke prevention is even more effective when patients are seen within 1 day of referral, rather than after a few days. The study showed that an immediate referral policy resulted in a 90-day stroke rate of 2.1% over the last 2.5 years, compared with a rate of 10.3% found in the preceding 2.5-year period, during which the median delay was 3 days. Baseline characteristics and delays in seeking medical attention were similar in both periods. A TIA service in Paris reported a similarly low stroke rate, although they did not include an internal control group. These results imply that patients with TIAs should be examined and treated within hours, rather than days.
众多临床试验表明，对于短暂性脑缺血发作（TIA）患者，采用外科手术（颈动脉内膜切除术）或药物治疗（抗血小板药物、降压药和他汀类药物）进行卒中预防是有效的。然而，在所有这些研究中，缺血事件与治疗之间的间隔为数周或数月。牛津大学最近发表的EXPRESS研究表明，若患者在转诊后1天内就诊，而非几天后就诊，卒中预防效果会更佳。该研究显示，在过去2.5年中，立即转诊策略使90天卒中发生率为2.1%，而在前一个2.5年期间，这一发生率为10.3%，当时的中位延迟时间为3天。两个时期的基线特征以及寻求医疗救治的延迟情况相似。巴黎的一个TIA服务机构报告了同样低的卒中发生率，尽管他们没有纳入内部对照组。这些结果表明，TIA患者应在数小时内而非数天内接受检查和治疗。
