Neurology Division, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, Brazil.
Neurology Division, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, Brazil.
J Stroke Cerebrovasc Dis. 2021 May;30(5):105677. doi: 10.1016/j.jstrokecerebrovasdis.2021.105677. Epub 2021 Mar 4.
Dual antiplatelet therapy (DAT) is a therapeutic option for patients with minor ischemic stroke (IS) or transient ischemic attack (TIA). No study has evaluated the incidence of early bleeding in patients with moderate to major ischemic stroke. The current study aimed to analyze both the frequency of early bleeding and hospital morbidity related to DAT for either acute IS or TIA regardless of admission National Institute of Health Stroke Scale (NIHSS) score.
This was a retrospective analysis based on data collected from a prospective data bank of a single center. We included patients who underwent DAT in the first 24 hours of symptom onset with a loading dose (aspirin 300 mg + clopidogrel 300 mg) on the first day, followed by a maintenance dose (aspirin 100 mg + clopidogrel 75 mg). We analyzed intracranial and/or extracranial hemorrhage that had occurred during the hospital admission, symptomatic bleeding, modified Rankin Scale (mRS) score at discharge, and death rates as outcomes.
Of the 119 patients analyzed, 94 (79 %) had IS and 25 (21 %) had TIA. Hemorrhage occurred in 11 (9.2 %) and four (3.4 %) patients with TIA or NIHSS ≤ 3, respectively, although none were symptomatic. Patients with bleeding as a complication had higher admission NIHSS [4 (3-7) vs. 2 (1-4), p = 0.044] and had higher mRS at discharge (mRS 2 [1-5] vs. mRS 1 [0-2], p = 0.008). These findings did not indicate increased mortality, as one (9 %) patient died from bleeding and two (1.8 %) patients died without bleeding (p = 0.254).
DAT seems to be a safe therapy in patients regardless of admission NIHSS if started within the first 24 h after symptom onset because only 1.6 % of patients had symptomatic bleeding.
双联抗血小板治疗（DAT）是治疗轻度缺血性卒中和短暂性脑缺血发作（TIA）患者的一种选择。目前尚无研究评估中至大面积缺血性卒患者早期出血的发生率。本研究旨在分析无论发病后入院时的国立卫生研究院卒中量表（NIHSS）评分如何，DAT 治疗急性缺血性卒中和 TIA 患者的早期出血频率和与 DAT 相关的院内发病率。
这是一项基于单中心前瞻性数据库数据的回顾性分析。我们纳入了在症状发作后 24 小时内接受 DAT 治疗的患者，首日负荷剂量为阿司匹林 300 mg+氯吡格雷 300 mg，随后维持剂量为阿司匹林 100 mg+氯吡格雷 75 mg。我们分析了住院期间发生的颅内和/或颅外出血、症状性出血、出院时改良 Rankin 量表（mRS）评分和死亡率等结局。
在分析的 119 例患者中，94 例（79%）为缺血性卒中和 25 例（21%）为 TIA。TIA 或 NIHSS≤3 的患者中分别有 4 例（3.4%）和 11 例（9.2%）发生出血，尽管均无症状。出血并发症患者入院 NIHSS 更高[4（3-7）比 2（1-4），p=0.044]，出院时 mRS 更高（mRS 2 [1-5]比 mRS 1 [0-2]，p=0.008）。这些发现并未表明死亡率增加，因为只有 1 例（9%）患者因出血死亡，2 例（1.8%）患者无出血死亡（p=0.254）。
如果在症状发作后 24 小时内开始 DAT，那么 DAT 似乎是一种安全的治疗方法，无论入院时 NIHSS 如何，因为只有 1.6%的患者发生症状性出血。
