Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina, USA.
Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Stroke Vasc Neurol. 2017 Jul 6;2(4):176-183. doi: 10.1136/svn-2017-000088. eCollection 2017 Dec.
Many patients receiving dual antiplatelet therapy still had recurrent strokes. We aimed to identify factors associated with recurrent stroke at 90 days in patients receiving dual antiplatelet therapy in Clopidogrel in High-risk patients with Acute Non-disabling Cerebrovascular Events trial.
Patients with transient ischaemic attack or minor stroke receiving clopidogrel and aspirin in the trial were analysed in the study. The primary outcome was recurrent stroke within 90 days after the index event. Cox proportional hazard model with backward selection was used to identify factors associated with stroke.
Among 2584 patients, 212 (8.2%) had a recurrent stroke, 216 (8.4%) had a composite of stroke, myocardial infarction, or vascular death and 204 (7.9%) had ischaemic stroke within 90 days. Multivariate analysis identified the following factors associated with stroke: history of hypertension with poor blood pressure control (HR, 1.92; 95% CI 1.22 to 3.03), the high baseline National Institute of Health Stroke Scale (NIHSS) score of 2 and 3 (2.12 (1.07 to 4.21) and 4.11 (2.05 to 8.22), respectively), time from onset to randomisation of <12 hours (1.47 (1.12 to 1.94)), the lipid-lowering therapy (0.61 (0.47 to 0.83)), the open-label aspirin dose at day 1 of ≥300 mg (1.98 (1.45 to 2.69)). Intracranial arterial stenosis (ICAS) was significantly associated with stroke in the sensitivity analysis (2.17 (1.16 to 4.04)).
The high baseline NIHSS score, hypertension with poor blood pressure control, ICAS, time from onset to randomisation of less than 12 hours and no lipid-lowering therapy were associated with stroke, suggesting that patients with identified predictors still remain to be at high risk of recurrent stroke although being under the dual antiplatelet therapy.
http://clinicaltrials.gov/show/NCT00979589. ClinicalTrials.gov number: NCT00979589.
许多接受双联抗血小板治疗的患者仍会发生复发性卒中。我们旨在确定在氯吡格雷治疗急性非致残性脑血管事件试验中接受双联抗血小板治疗的患者 90 天内复发性卒中的相关因素。
对该试验中接受氯吡格雷和阿司匹林治疗的短暂性脑缺血发作或小卒中患者进行分析。主要结局是指数事件后 90 天内复发性卒中。采用向后选择的 Cox 比例风险模型来确定与卒中相关的因素。
在 2584 例患者中，212 例（8.2%）发生复发性卒中，216 例（8.4%）发生卒中、心肌梗死或血管性死亡的复合结局，204 例（7.9%）发生缺血性卒中。多变量分析确定与卒中相关的因素包括：高血压病史且血压控制不佳（HR，1.92；95%CI，1.22 至 3.03）、基线 NIHSS 评分较高（2 分和 3 分分别为 2.12（1.07 至 4.21）和 4.11（2.05 至 8.22））、发病至随机分组时间<12 小时（1.47（1.12 至 1.94））、降脂治疗（0.61（0.47 至 0.83））、第 1 天开放标签阿司匹林剂量≥300mg（1.98（1.45 至 2.69））。颅内动脉狭窄（ICAS）在敏感性分析中与卒中显著相关（2.17（1.16 至 4.04））。
基线 NIHSS 评分较高、高血压且血压控制不佳、ICAS、发病至随机分组时间<12 小时且无降脂治疗与卒中相关，这表明尽管接受双联抗血小板治疗，具有上述预测因素的患者仍存在较高的复发性卒中风险。
http://clinicaltrials.gov/show/NCT00979589. ClinicalTrials.gov 编号：NCT00979589。
Zotero 插件