Department of Neurology, University of Miami, Miller School of Medicine, Miami, Florida.
Department of Neurology, University of Maryland, Baltimore, Maryland.
J Am Coll Cardiol. 2019 Aug 13;74(6):786-803. doi: 10.1016/j.jacc.2019.06.039.
Stroke survivors carry a high risk of recurrence. Antithrombotic medications are paramount for secondary prevention and thus crucial to reduce the overall stroke burden. Appropriate antithrombotic agent selection should be based on the best understanding of the physiopathological mechanism that led to the initial ischemic injury. Antiplatelet therapy is preferred for lesions characterized by atherosclerosis and endothelial injury, whereas anticoagulant agents are favored for cardiogenic embolism and highly thrombophilic conditions. Large randomized controlled trials have provided new data to support recommendations for the evidence-based use of antiplatelet agents and anticoagulant agents after stroke. In this review, the authors cover recent trials that have altered clinical practice, cite systematic reviews and meta-analyses, review evidence-based recommendations based on older landmark trials, and indicate where there are still evidence-gaps and new trials being conducted.
脑卒中幸存者具有较高的复发风险。抗血栓药物对于二级预防至关重要，可降低整体脑卒中负担。抗栓药物的选择应基于对导致初始缺血性损伤的病理生理机制的最佳理解。抗血小板治疗适用于动脉粥样硬化和内皮损伤的病变，而抗凝药物则适用于心源性栓塞和高血栓形成状态。大型随机对照试验提供了新的数据，支持基于证据的抗血小板药物和抗凝药物在脑卒中后的应用建议。在这篇综述中，作者涵盖了改变临床实践的最新试验，引用了系统评价和荟萃分析，回顾了基于旧的里程碑试验的循证推荐，并指出了仍存在证据空白和正在进行的新试验的领域。
