Tziomalos Konstantinos, Giampatzis Vasilios, Bouziana Stella D, Spanou Marianna, Kostaki Stavroula, Papadopoulou Maria, Angelopoulou Stella-Maria, Tsopozidi Maria, Savopoulos Christos, Hatzitolios Apostolos I
First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece.
Cerebrovasc Dis. 2016;41(5-6):226-32. doi: 10.1159/000443745. Epub 2016 Jan 22.
Clopidogrel reduces the risk of non-cardioembolic ischemic stroke, but it is unclear whether it affects the severity and outcome of stroke. We aimed at evaluating the effect of prior treatment with clopidogrel on acute non-cardioembolic ischemic stroke severity and in-hospital outcome.
We prospectively studied 608 consecutive patients (39.5% males, age 79.1 ± 6.6 years) who were admitted with acute ischemic stroke. The severity of stroke was assessed at admission with the National Institutes of Health Stroke Scale (NIHSS). Severe stroke was defined as NIHSS ≥21. The outcome was assessed using the dependency rates that prevailed at the time of discharge (i.e. modified Rankin scale between 2 and 5) and with in-hospital mortality.
At admission, 397 patients did not have atrial fibrillation or heart valve disease. Among these 397 patients, 69 were receiving monotherapy with clopidogrel prior to stroke, 69 were receiving monotherapy with aspirin and 236 patients were not on any antiplatelet treatment. The prevalence of severe stroke was lower in patients who were receiving clopidogrel than in patients who were receiving aspirin and patients who were not on antiplatelets (1.4, 13.0 and 11.0%, respectively; p < 0.05). Independent predictors of severe stroke at admission were male gender (relative risk (RR) 0.31, 95% CI 0.12-0.78, p < 0.05) and treatment with clopidogrel prior to stroke compared with no antiplatelet treatment (RR 0.13, 95% CI 0.02-0.97, p < 0.05). Treatment with aspirin prior to stroke did not predict severe stroke compared with no antiplatelet treatment (RR 1.24, 95% CI 0.51-2.98, p = NS). The rate of dependency at discharge did not differ between patients who were receiving clopidogrel, patients who were receiving aspirin and those who were not on antiplatelets (57.9, 47.8 and 59.7%, respectively; p = NS). Independent predictors of dependency at discharge were age (RR 1.12, 95% CI 1.05-1.19, p < 0.001) and NIHSS at admission (RR 1.67, 95% CI 1.46-1.92, p < 0.001). In-hospital mortality rate also did not differ between patients who were receiving clopidogrel, patients who were receiving aspirin and those who were not on antiplatelets (4.3, 4.3 and 5.0%, respectively; p = NS). The only independent predictor of in-hospital mortality was NIHSS at admission (RR 1.22, 95% CI 1.14-1.30, p < 0.001).
Treatment with clopidogrel prior to acute non-cardioembolic ischemic stroke attenuates the severity of stroke at admission but does not appear to affect the functional outcome at discharge or the in-hospital mortality of these patients.
氯吡格雷可降低非心源性缺血性卒中的风险，但尚不清楚其是否会影响卒中的严重程度及预后。我们旨在评估氯吡格雷预先治疗对急性非心源性缺血性卒中严重程度及住院期间预后的影响。
我们前瞻性地研究了608例连续入院的急性缺血性卒中患者（男性占39.5%，年龄79.1±6.6岁）。入院时使用美国国立卫生研究院卒中量表（NIHSS）评估卒中严重程度。严重卒中定义为NIHSS≥21。使用出院时的依赖率（即改良Rankin量表评分为2至5分）及住院死亡率评估预后。
入院时，397例患者无房颤或心脏瓣膜病。在这397例患者中，69例在卒中前接受氯吡格雷单药治疗，69例接受阿司匹林单药治疗，236例未接受任何抗血小板治疗。接受氯吡格雷治疗的患者中严重卒中的发生率低于接受阿司匹林治疗的患者及未接受抗血小板治疗的患者（分别为1.4%、13.0%和11.0%；p<0.05）。入院时严重卒中的独立预测因素为男性（相对风险（RR）0.31，95%置信区间0.12 - 0.78，p<0.05）以及与未接受抗血小板治疗相比，卒中前接受氯吡格雷治疗（RR 0.13，95%置信区间0.02 - 0.97，p<0.05）。与未接受抗血小板治疗相比，卒中前接受阿司匹林治疗不能预测严重卒中（RR 1.24，95%置信区间0.51 - 2.98，p = 无统计学意义）。接受氯吡格雷治疗的患者、接受阿司匹林治疗的患者及未接受抗血小板治疗的患者出院时的依赖率无差异（分别为57.9%、47.8%和59.7%；p = 无统计学意义）。出院时依赖的独立预测因素为年龄（RR 1.12，95%置信区间1.05 - 1.19，p<0.001）及入院时的NIHSS（RR 1.67，95%置信区间1.46 - 1.92，p<0.001）。接受氯吡格雷治疗的患者、接受阿司匹林治疗的患者及未接受抗血小板治疗的患者住院死亡率也无差异（分别为4.3%、4.3%和5.0%；p = 无统计学意义）。住院死亡率的唯一独立预测因素为入院时的NIHSS（RR 1.22，95%置信区间1.14 - 1.30，p<0.001）。
急性非心源性缺血性卒中前使用氯吡格雷治疗可减轻入院时卒中的严重程度，但似乎不影响这些患者出院时的功能预后或住院死亡率。
