Department of Medicine and Surgery, Research Center on Thromboembolic Disorders and Antithrombotic Therapies, University of Insubria, Varese, Italy.
J Thromb Thrombolysis. 2019 Aug;48(2):336-344. doi: 10.1007/s11239-019-01893-y.
One-third to one-half of ischemic strokes occurred in patients taking antiplatelet drugs. The optimal therapeutic strategy for antithrombotic drugs remains uncertain and guidelines provide scarse recommendation. Therefore, aims of our study were to: (i) estimate the prevalence of patients who develop an ischemic stroke while on antiplatelet drugs, (ii) investigate potential factors associated with this phenomenon, (iii) describe management strategies in daily clinical practice. Consecutive adult patients admitted for acute ischemic stroke at the academic hospital of Varese, Italy, from January 2010 till December 2011 were included. Patients were retrospectively identified by searching the administrative database of the hospital. Odds ratios (ORs) and their 95% confidence intervals (CI) for identifying factors associated with dependent variable were estimated using univariate logistic regression. Any variable with a p value < 0.2 at univariate analysis was included in a multivariate model. A total of 419 patients were included. Patients with ischemic stroke while on antiplatelet drugs were 49.6%. The following baseline characteristics were associated with the occurrence of ischemic stroke in patients taking antiplatelet drugs: diabetes mellitus (DM), history of ischemic heart disease (IHD), age > 65 years and previous stroke or transient ischemic stroke (TIA). The following variables were significantly associated with a change of antithrombotic therapy at discharge: DM, history of IHD and previous stroke or TIA. Our study confirms that the occurrence of ischemic stroke during antiplatelet treatment is common and management of antithrombotic therapy is heterogeneous. Factors that may explain therapeutic failure include undetected cardioembolic sources, drug resistance, poor compliance, or the presence of diabetes, atherothrombotic disease, and advanced age. Randomized controlled trials are warranted to assess the optimal antithrombotic strategy for ischemic stroke occurred in patients taking antiplatelet drugs.
三分之一至一半的缺血性中风发生在服用抗血小板药物的患者中。抗血栓药物的最佳治疗策略仍不确定，指南提供的建议很少。因此，我们的研究目的是：（i）估计在服用抗血小板药物的患者中发生缺血性中风的患者比例，（ii）调查与这种现象相关的潜在因素，（iii）描述日常临床实践中的管理策略。连续纳入 2010 年 1 月至 2011 年 12 月期间在意大利瓦雷泽学术医院因急性缺血性中风住院的成年患者。通过搜索医院的行政数据库，回顾性地确定患者。使用单变量逻辑回归估计与因变量相关的因素的比值比（OR）及其 95%置信区间（CI）。单变量分析中 p 值<0.2 的任何变量均包含在多变量模型中。共纳入 419 例患者。在服用抗血小板药物的患者中，缺血性中风的发生率为 49.6%。与服用抗血小板药物的患者发生缺血性中风相关的基线特征包括：糖尿病（DM）、缺血性心脏病（IHD）病史、年龄>65 岁和既往中风或短暂性脑缺血发作（TIA）。与出院时抗血栓治疗变化显著相关的变量包括：DM、IHD 病史和既往中风或 TIA。我们的研究证实，抗血小板治疗期间发生缺血性中风较为常见，抗血栓治疗的管理存在异质性。导致治疗失败的因素可能包括未检测到的心源性栓塞源、药物抵抗、依从性差或存在糖尿病、动脉粥样硬化性疾病和高龄。需要进行随机对照试验来评估在服用抗血小板药物的患者中发生缺血性中风的最佳抗血栓策略。
