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Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association.急性缺血性脑卒中患者早期管理指南:2018 年急性缺血性脑卒中早期管理指南的更新:美国心脏协会/美国卒中协会发布的医疗保健专业人员指南。
Stroke. 2019 Dec;50(12):e344-e418. doi: 10.1161/STR.0000000000000211. Epub 2019 Oct 30.
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Time Course for Benefit and Risk of Clopidogrel and Aspirin After Acute Transient Ischemic Attack and Minor Ischemic Stroke.急性短暂性脑缺血发作和小卒中后氯吡格雷和阿司匹林获益与风险的时间进程。
Circulation. 2019 Aug 20;140(8):658-664. doi: 10.1161/CIRCULATIONAHA.119.040713. Epub 2019 Jun 26.
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Aspirin resistance predicts unfavorable functional outcome in acute ischemic stroke patients.阿司匹林抵抗预测急性缺血性脑卒中患者不良功能结局。
Brain Res Bull. 2018 Sep;142:176-182. doi: 10.1016/j.brainresbull.2018.07.004. Epub 2018 Jul 24.
4
Efficacy and safety of dual antiplatelet therapy in the elderly for stroke prevention: a systematic review and meta-analysis.双联抗血小板治疗在老年人群预防卒中的疗效和安全性:系统评价和荟萃分析。
Eur J Neurol. 2018 Oct;25(10):1276-1284. doi: 10.1111/ene.13695. Epub 2018 Jul 6.
5
Increased platelet count and reticulated platelets in recently symptomatic versus asymptomatic carotid artery stenosis and in cerebral microembolic signal-negative patient subgroups: results from the HaEmostasis In carotid STenosis (HEIST) study.近期有症状 versus 无症状颈动脉狭窄患者亚组及脑微栓子信号阴性患者亚组的血小板计数和网织血小板增加:来自 HaEmostasis In carotid STenosis(HEIST)研究的结果。
J Neurol. 2018 May;265(5):1037-1049. doi: 10.1007/s00415-018-8797-8. Epub 2018 Feb 23.
6
Thrombotic Paradox: Ischaemic Stroke in Immune Thrombocytopaenia. A Case Report and Review.血栓形成悖论:免疫性血小板减少症患者的缺血性中风。病例报告及文献综述
Cureus. 2017 Dec 3;9(12):e1904. doi: 10.7759/cureus.1904.
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Postoperative thrombocytopenia: why you should consider antiplatelet therapy?
Curr Opin Anaesthesiol. 2018 Feb;31(1):61-66. doi: 10.1097/ACO.0000000000000551.
8
Prevalence, Incidence, and Mortality of Stroke in China: Results from a Nationwide Population-Based Survey of 480 687 Adults.中国脑卒中的患病率、发病率和死亡率:一项基于全国 480687 名成年人的人口普查研究结果。
Circulation. 2017 Feb 21;135(8):759-771. doi: 10.1161/CIRCULATIONAHA.116.025250. Epub 2017 Jan 4.
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Global stroke statistics.全球中风统计数据。
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10
Risks of Bleeding Recurrence and Cardiovascular Events With Continued Aspirin Use After Lower Gastrointestinal Hemorrhage.下消化道出血后继续使用阿司匹林的出血复发和心血管事件风险。
Gastroenterology. 2016 Aug;151(2):271-7. doi: 10.1053/j.gastro.2016.04.013. Epub 2016 Apr 26.

脑梗死伴血小板减少症患者抗血小板治疗的长期安全性和疗效。

Long-Term Safety and Efficacy of Antiplatelet Therapy in Patients With Cerebral Infarction With Thrombocytopenia.

机构信息

Department of Neurology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.

Gordon F. Derner School of Psychology General Psychology, Adelphi University, New York, United States.

出版信息

Clin Appl Thromb Hemost. 2021 Jan-Dec;27:1076029620980067. doi: 10.1177/1076029620980067.

DOI:10.1177/1076029620980067
PMID:33443453
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7812396/
Abstract

This study aimed to investigate the long-term safety and benefits of antiplatelet therapy in patients with cerebral infarction with thrombocytopenia, as evidence regarding this was limited. This cohort trial assessed patients with acute cerebral infarction with thrombocytopenia treated in the Neurology Department of Shanghai Tenth People's Hospital from January 2016 to December 2018, and enrolled patients were followed up for 9 months. The patients were divided into non-antiplatelet and antiplatelet groups based on the actual intake of antiplatelet drugs. Primary endpoints included hemorrhagic events, recurrence of cerebral infarction, and activity of daily living (ADL) score changes. To balance baseline clinical data, propensity score matching was applied, and there were finally 65 matched patients, including 30 and 35 in the antiplatelet and non-antiplatelet groups, respectively. There were no differences in hemorrhagic and cerebral infarction recurrence rates between the 2 groups. ADL score change was higher in the antiplatelet group than in the non-antiplatelet group (10 vs 5, = 0.039). In multivariate regression analysis, antiplatelet therapy significantly predicted a positive change in ADL scores [B = 8.381, 95% confidence interval (0.56-16.19)]. In patients with acute cerebral infarction with thrombocytopenia, antiplatelet therapy could the improve the quality of life in the chronic stage.

摘要

本研究旨在探讨伴有血小板减少症的脑梗死患者抗血小板治疗的长期安全性和获益,因为这方面的证据有限。这项队列研究评估了 2016 年 1 月至 2018 年 12 月在上海第十人民医院神经内科治疗的伴有血小板减少症的急性脑梗死患者,并对患者进行了 9 个月的随访。根据实际抗血小板药物的摄入情况,将患者分为非抗血小板和抗血小板组。主要终点包括出血事件、脑梗死复发和日常生活活动(ADL)评分变化。为了平衡基线临床数据,应用了倾向评分匹配,最终有 65 例匹配患者,其中抗血小板组和非抗血小板组各有 30 例和 35 例。两组的出血和脑梗死复发率无差异。抗血小板组 ADL 评分的变化高于非抗血小板组(10 分比 5 分, = 0.039)。多变量回归分析显示,抗血小板治疗显著预测 ADL 评分的积极变化[B = 8.381,95%置信区间(0.56-16.19)]。在伴有血小板减少症的急性脑梗死患者中,抗血小板治疗可以改善慢性期的生活质量。