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当前预防中风的抗血小板治疗中的问题:中风亚型的重要性以及中风和 MI 患者之间的差异。

Current issues in antiplatelet therapy for stroke prevention: the importance of stroke subtypes and differences between stroke and MI patients.

机构信息

Vanderbilt Stroke Center, A-0118 Vanderbilt Medical Center North, Nashville, TN 37232, USA.

出版信息

J Neurol. 2010 Nov;257(11):1788-97. doi: 10.1007/s00415-010-5667-4. Epub 2010 Jul 22.

Abstract

Ischaemic stroke, the most common type of stroke, is classified into three main subtypes: large-vessel disease, lacunar or small-vessel disease, and cardioembolic; two further subtypes include a determined aetiology of "other" and cryptogenic. Although a substantial amount of literature exists concerning current guidelines for the secondary prevention of ischaemic stroke, treatment strategies for stroke subtypes as well as the reasons why these subtypes are significant have yet to be clearly defined. Furthermore, treatment strategies for secondary prevention of ischaemic stroke differ between patients who have suffered a previous stroke and those who have suffered a myocardial infarction. Antiplatelet therapies offer treatment that is as efficacious as warfarin, but with less severe bleeding. This review examines the importance of the different subtypes of stroke as well as differentiating between treating a heart patient and a stroke patient for secondary stroke prevention, including the advantages of using antiplatelet therapy over anticoagulants.

摘要

缺血性脑卒中是最常见的脑卒中类型,可分为三大主要亚型:大血管病变、腔隙或小血管病变和心源性栓塞;另外两个进一步的亚型包括“其他”和隐源性的确定病因。尽管有大量文献涉及缺血性脑卒中二级预防的现行指南,但脑卒中亚型的治疗策略以及这些亚型为何重要尚未明确界定。此外,既往发生过脑卒中与发生过心肌梗死的患者二级预防缺血性脑卒中的治疗策略有所不同。抗血小板治疗的疗效与华法林相当,但出血风险更小。本综述探讨了不同脑卒中亚型的重要性,以及区分心脏患者和脑卒中患者进行二级脑卒中预防的重要性,包括使用抗血小板治疗优于抗凝治疗的优势。

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