Coveney Sarah, McCabe John J, Murphy Sean, O'Donnell Martin, Kelly Peter J
Irish Stroke Clinical Trials Network, Mater Misericordiae University Hospital, Dublin 7, Ireland.
Department of Geriatric Medicine, Mater Misericordiae University Hospital, Dublin 7, Ireland.
Cochrane Database Syst Rev. 2020 May 11;5(5):CD012825. doi: 10.1002/14651858.CD012825.pub2.
An increasing body of evidence suggests that inflammation plays a key role in stroke, in particular stroke of atherosclerotic origin. Anti-inflammatory medications are a widely heterogeneous group of drugs that are used to suppress the innate inflammatory pathway and thus prevent persistent or recurrent inflammation. Anti-inflammatory agents have the potential to stabilise atherosclerotic plaques by impeding the inflammatory pathway. By targeting specific cytokines, the inflammatory pathway may be interrupted at various stages.
To assess the benefits and harms of anti-inflammatory medications plus standard care versus standard care with or without placebo for prevention of vascular events (stroke, myocardial infarction (MI), non-fatal cardiac arrest, unstable angina requiring revascularisation, vascular death) and all-cause mortality in people with a prior history of ischaemic stroke or transient ischaemic attack (TIA).
We searched the Cochrane Central Register of Controlled Trials (CENTRAL; last searched 29 May 2019); MEDLINE (1948 to 29 May 2019); Embase (1980 to 29 May 2019); the Cumulative Index to Nursing and Allied Health Literature (CINAHL; 1982 to 29 May 2019); and Scopus (1995 to 29 May 2019). In an effort to identify additional published, unpublished, and ongoing trials, we searched several grey literature sources (last searched 30 May 2019). We incorporated all identified studies into the results section. We applied no restrictions with respect to language, date of publication, or study setting.
We considered randomised controlled trials (RCTs) and cluster-randomised controlled trials that evaluated anti-inflammatory medications for prevention of major cardiovascular events following ischaemic stroke or TIA.
Two review authors independently assessed for inclusion titles and abstracts of studies identified by the search. Two review authors independently reviewed full-text articles for inclusion in this review. We planned to assess risk of bias and to apply the GRADE method.
We identified no studies that met the inclusion criteria.
AUTHORS' CONCLUSIONS: There is currently a paucity of evidence on the use of anti-inflammatory medications for prevention of major cardiovascular events following ischaemic stroke or TIA. RCTs are needed to assess whether use of anti-inflammatory medications in this setting is beneficial.
越来越多的证据表明，炎症在中风尤其是动脉粥样硬化性中风中起关键作用。抗炎药物是一大类广泛的异质性药物，用于抑制先天性炎症途径，从而预防持续性或复发性炎症。抗炎药物有可能通过阻碍炎症途径来稳定动脉粥样硬化斑块。通过靶向特定细胞因子，炎症途径可能在不同阶段被中断。
评估抗炎药物加标准治疗与标准治疗（有或无安慰剂）相比，对有缺血性中风或短暂性脑缺血发作（TIA）病史的人群预防血管事件（中风、心肌梗死（MI）、非致命性心脏骤停、需要血运重建的不稳定型心绞痛、血管性死亡）和全因死亡率的益处和危害。
我们检索了Cochrane对照试验中心注册库（CENTRAL；最后检索时间为2019年5月29日）；MEDLINE（1948年至2019年5月29日）；Embase（1980年至2019年5月29日）；护理及相关健康文献累积索引（CINAHL；1982年至2019年5月29日）；以及Scopus（1995年至2019年5月29日）。为了识别更多已发表、未发表和正在进行的试验，我们检索了多个灰色文献来源（最后检索时间为2019年5月30日）。我们将所有识别出的研究纳入结果部分。我们对语言、发表日期或研究背景没有限制。
我们考虑了评估抗炎药物预防缺血性中风或TIA后主要心血管事件的随机对照试验（RCT）和整群随机对照试验。
两位综述作者独立评估检索到的研究的标题和摘要是否纳入。两位综述作者独立审查全文文章以纳入本综述。我们计划评估偏倚风险并应用GRADE方法。
我们未识别出符合纳入标准的研究。
目前关于使用抗炎药物预防缺血性中风或TIA后主要心血管事件的证据不足。需要进行随机对照试验来评估在此情况下使用抗炎药物是否有益。
