缺血性卒中后抗血小板治疗依从性与长期死亡率：一项全国性研究。
Non-persistence with anti-platelet therapy and long-term mortality after ischemic stroke: A nationwide study.
作者信息
Kim Seung Jae, Kwon Oh Deog, Choi Ho Chun, Lee Eung-Joon, Cho BeLong
机构信息
Department of Family Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Republic of Korea Navy 2nd Fleet Medical Corps, Pyeongtaek-si, Gyeonggi-do, Republic of Korea.
出版信息
PLoS One. 2021 Feb 9;16(2):e0244718. doi: 10.1371/journal.pone.0244718. eCollection 2021.
BACKGROUND
We tried to investigate the effect of non-persistence with antiplatelets after ischemic stroke on long-term all-cause mortality (ACM).
METHODS AND FINDINGS
We selected newly diagnosed ischemic stroke patients aged ≥20years who were newly treated with aspirin or clopidogrel from 2003-2010 Korean National Health Insurance Service-National Sample Cohort, a random sample of 2.2% of total population. Subjects were divided into two pairs of groups according to persistence with antiplatelets at 6 and 12 months: those who discontinued antiplatelets within 6 months (DA6M) and those who continued them for 6 or months or more (CA6M); and those who discontinued antiplatelets within 12 months (DA12M) and those who continued them for 12 months or more (CA12M). Those who died within 6 months among DA6M and those who died within 12 months among DA12M were excluded along with those with medication possession ratio<80% among CA6M and CA12M. Subjects were followed-up until death or December 31, 2013. Among 3,559 total subjects, DA6M were 1,080 and CA6M were 2,479 while, out of 3,628 total patients, DA12M were 1,434 and CA12M were 2,194. The risks of ACM [adjusted hazard ratio (aHR), 2.25; 95% confidence interval (CI), 1.94-2.61], cerebro-cardiovascular disease (CVD) death (aHR, 2.52; 95% CI, 1.96-3.24) and non-CVD death (aHR, 2.11; 95% CI, 1.76-2.64) of DA6M were all significantly increased compared to CA6M. DA12M also had significantly higher risks of ACM (aHR, 1.93; 95% CI, 1.65-2.25), CVD mortality (aHR, 2.13; 95% CI; 1.63-2.77) and non-CVD mortality (aHR, 1.83;95% CI 1.51-2.22) than DA12M but aHRs were lower than that between DA6M and CA6M. The difference rates of ACM, CVD death, and non-CVD death between non-persistent and persistent groups all continuously widened over time but the degree of difference was gradually decreased.
CONCLUSIONS
Maintaining antiplatelets for the first 12 months after ischemic stroke reduces long-term risks of both CVD death and non-CVD death.
背景
我们试图研究缺血性中风后停用抗血小板药物对长期全因死亡率（ACM）的影响。
方法与结果
我们从2003年至2010年韩国国民健康保险服务全国样本队列中选取年龄≥20岁、新接受阿司匹林或氯吡格雷治疗的新诊断缺血性中风患者，该队列是总人口的2.2%随机样本。根据6个月和12个月时抗血小板药物的持续使用情况，将受试者分为两组：在6个月内停用抗血小板药物的患者（DA6M）和持续使用6个月或更长时间的患者（CA6M）；以及在12个月内停用抗血小板药物的患者（DA12M）和持续使用12个月或更长时间的患者（CA12M）。将DA6M中6个月内死亡的患者、DA12M中12个月内死亡的患者以及CA6M和CA12M中药物持有率<80%的患者排除。对受试者进行随访直至死亡或2013年12月31日。在3559名总受试者中，DA6M有1080名，CA6M有2479名；而在3628名总患者中，DA12M有1434名，CA12M有2194名。与CA6M相比，DA6M的ACM风险[调整后风险比（aHR），2.25；95%置信区间（CI），1.94 - 2.61]、心脑血管疾病（CVD）死亡风险（aHR，2.52；95% CI，1.96 - 3.24）和非CVD死亡风险（aHR，2.11；95% CI，1.76 - 2.64）均显著增加。DA12M的ACM风险（aHR，1.93；95% CI，1.65 - 2.25）、CVD死亡率（aHR，2.13；95% CI；1.63 - 2.77）和非CVD死亡率（aHR，1.83；95% CI 1.51 - 2.22）也显著高于CA12M，但aHR低于DA6M和CA6M之间的aHR。非持续组和持续组之间的ACM、CVD死亡和非CVD死亡差异率均随时间持续扩大，但差异程度逐渐减小。
结论
缺血性中风后前12个月维持使用抗血小板药物可降低CVD死亡和非CVD死亡的长期风险。
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