Department of Neurology, Third Affiliated Hospital of Wenzhou Medical University.
Department of Neurology, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University.
J Atheroscler Thromb. 2019 Jun 1;26(6):528-537. doi: 10.5551/jat.46136. Epub 2018 Nov 14.
To evaluate the effect of prestroke aspirin (PA) use on initial stroke severity, early neurologic deterioration (END), stroke recurrence, hemorrhagic transformation (HT), and functional outcome in patients with ischemic stroke (IS).
This was a prospective, observational, multicenter cohort study. The acute IS patients with atherothrombosis (AT), small artery disease (SAD), or cardioembolic (CE) stroke within 24 hours of symptom onset were identified. National Institutes of Health Stroke Scale (NIHSS) scores on admission, clinical outcomes (END, recurrent ischemic stroke [RIS], myocardial infarction [MI], death, and hemorrhagic episodes), and functional outcome (modified Rankin Scale [mRS] scores) at three months after admission were compared between PA users and nonusers.
Among the 1,862 patients, 401 (21.5%) reported PA use. The PA users had a significantly lower initial NIHSS score than the non-PA users. The effect was evident in AT stroke, but not in other subtypes. PA use was independently associated with the decreased risk of END. PA use increased the risk of HT; however, it was only associated with increased risk for asymptomatic HT, not for symptomatic HT. PA use was associated with better functional outcomes (mRS scores ≤2 points) irrespective of stroke subtypes at three months after admission, despite the increased risk of HT.
PA use may reduce initial stroke severity in AT stroke and the risk of END, and can improve functional outcome at three months irrespective of stroke subtypes.
评估缺血性脑卒中（IS）患者发病前使用阿司匹林（PA）对初始卒中严重程度、早期神经功能恶化（END）、卒中复发、出血转化（HT）和功能结局的影响。
这是一项前瞻性、观察性、多中心队列研究。在症状发作后 24 小时内，对动脉粥样硬化（AT）、小动脉疾病（SAD）或心源性栓塞（CE）IS 患者进行研究。比较入院时国立卫生研究院卒中量表（NIHSS）评分、入院后 3 个月的临床结局（END、复发性缺血性卒中[RIS]、心肌梗死[MI]、死亡和出血事件）和功能结局（改良 Rankin 量表[mRS]评分）在 PA 使用组和非使用组之间的差异。
在 1862 例患者中，有 401 例（21.5%）报告使用 PA。PA 使用组的初始 NIHSS 评分显著低于非 PA 使用组。这种影响在 AT 型卒中中更为明显，但在其他亚型中则不明显。PA 使用与 END 风险降低独立相关。PA 使用增加 HT 的风险；然而，它仅与无症状 HT 的风险增加相关，而与有症状 HT 的风险增加无关。PA 使用与功能结局改善（mRS 评分≤2 分）相关，与卒中亚型无关，尽管 HT 的风险增加。
PA 使用可能降低 AT 型卒中的初始卒中严重程度和 END 风险，并能改善入院后 3 个月的功能结局，无论卒中亚型如何。
