John Seby, Katzan Irene
Cerebrovascular Center, Cleveland Clinic, 9500 Euclid Avenue, S80, Cleveland, OH 44195, USA.
Neurological Institute Center for Outcomes Research & Evaluation, Cleveland Clinic, 9500 Euclid Avenue, S80, Cleveland, OH 44195, USA.
Neurol Clin. 2015 May;33(2):475-89. doi: 10.1016/j.ncl.2014.12.007. Epub 2015 Feb 2.
Of the ≈795,000 strokes in the United States annually, 185,000 are recurrent. A third to half of them occur while on antiplatelet therapy. Multiple reasons could explain breakthrough stroke while on antiplatelet therapy. Management of recurrent stroke requires a meticulous search for the cause and mechanism of stroke. At present, there is no indication for antiplatelet resistance testing in ischemic stroke, or adjusting medications based on its results. Recent trials have shown the effectiveness of dual antiplatelet therapy in the acute period after an ischemic event, but no benefit has been found with this regimen for long-term secondary prevention.
在美国,每年约79.5万例中风患者中,有18.5万例为复发性中风。其中三分之一至一半发生在接受抗血小板治疗期间。抗血小板治疗期间发生突破性中风可能有多种原因。复发性中风的管理需要对中风的病因和机制进行细致排查。目前,缺血性中风中尚无抗血小板抵抗检测的指征,也没有根据检测结果调整用药的依据。近期试验表明,双重抗血小板治疗在缺血性事件急性期有效,但该方案用于长期二级预防未发现有益效果。