急性症状性颈动脉狭窄（热颈动脉）患者管理中的 equipoise（该词可能有误，推测可能是equilibrium“平衡”等类似含义，因原词不太准确，这里按原词翻译）
Equipoise in Management of Patients With Acute Symptomatic Carotid Stenosis (Hot Carotid).
作者信息
Ganesh Aravind, Bartolini Luca, Singh Ravinder-Jeet, Al-Sultan Abdulaziz S, Campbell David J T, Wong John H, Menon Bijoy K
机构信息
Department of Clinical Neurosciences (AG, R-JS, ASA-S, JHW, BKM), University of Calgary, Canada; Clinical Epilepsy Section (LB), National Institutes of Health, Bethesda, MD; Centre for Urban Health Solutions (DJTC), St. Michael's Hospital, Toronto, Canada; and Department of Medicine (DJTC), Department of Community Health Sciences (DJTC, BKM), Department of Radiology (JHW, BKM), and The Hotchkiss Brain Institute (JHW, BKM), University of Calgary, Canada.
出版信息
Neurol Clin Pract. 2021 Feb;11(1):25-32. doi: 10.1212/CPJ.0000000000000812.
OBJECTIVE
To explore differences in antithrombotic management of patients with acutely symptomatic carotid stenosis ("hot carotid") awaiting revascularization with endarterectomy or stenting (CEA/CAS).
METHODS
We used a worldwide electronic survey with practice-related questions and clinical questions about 3 representative scenarios. Respondents chose their preferred antithrombotic regimen (1) in general, (2) if the patient was already on aspirin, or (3) had associated intraluminal thrombus (ILT) and identified clinical/imaging factors that increased or decreased their enthusiasm for additional antithrombotic agents. Responses among different groups were compared using multivariable logistic regression.
RESULTS
We received 668 responses from 71 countries. The majority favored CT angiography (70.2%) to evaluate carotid stenosis, CEA (69.1%) over CAS, an aspirin-containing regimen (88.5%), and a clopidogrel-containing regimen (64.4%) if already on aspirin. Whereas diverse antithrombotic regimens were chosen, monotherapy was favored by 54.4%-70.6% of respondents across 3 scenarios. The preferred dual therapy was low-dose aspirin (75-100 mg) plus clopidogrel (22.2%) or high-dose aspirin (160-325 mg) plus clopidogrel if already on aspirin (12.2%). Respondents favoring CAS more often chose ≥2 agents (adjusted odds ratio [aOR] vs CEA: 2.00, 95% confidence interval 1.36-2.95, = 0.001) or clopidogrel-containing regimens (aOR: 1.77, 1.16-2.70, = 0.008). Regional differences included respondents from Europe less commonly choosing multiple agents if already on aspirin (aOR vs United States/Canada: 0.57, 0.35-0.93, = 0.023), those from Asia more often favoring multiple agents (aOR: 1.95, 1.11-3.43, = 0.020), vs those from the United States/Canada preferentially choosing heparin-containing regimens with ILT (aOR vs rest: 3.35, 2.23-5.03, < 0.001). Factors increasing enthusiasm for ≥2 antithrombotics included multiple TIAs (57.2%), ILT (58.5%), and ulcerated plaque (57.4%); 56.3% identified MRI microbleeds as decreasing enthusiasm.
CONCLUSIONS
Our results highlight the heterogeneous management and community equipoise surrounding optimal antithrombotic regimens for hot carotids.
目的
探讨等待接受内膜切除术或支架置入术（CEA/CAS）进行血运重建的急性症状性颈动脉狭窄患者（“热颈动脉”）在抗血栓治疗管理方面的差异。
方法
我们开展了一项全球电子调查，包含与实践相关的问题以及关于3种代表性病例的临床问题。受访者选择他们偏好的抗血栓治疗方案：（1）一般情况下；（2）患者已在服用阿司匹林时；或（3）伴有腔内血栓（ILT）时，并确定增加或降低他们对额外抗血栓药物使用热情的临床/影像因素。使用多变量逻辑回归比较不同组之间的回答。
结果
我们收到了来自71个国家的668份回复。大多数人倾向于采用CT血管造影（70.2%）来评估颈动脉狭窄，CEA（69.1%）优于CAS，倾向于含阿司匹林的治疗方案（88.5%），以及患者已在服用阿司匹林时倾向于含氯吡格雷的治疗方案（64.4%）。尽管选择了多种不同的抗血栓治疗方案，但在3种病例中，54.4%-70.6%的受访者更倾向于单一疗法。首选的联合疗法是低剂量阿司匹林（75-100mg）加氯吡格雷（22.2%），或者患者已在服用阿司匹林时采用高剂量阿司匹林（160-325mg）加氯吡格雷（12.2%）。更倾向于CAS的受访者更常选择≥2种药物（与CEA相比，调整后的优势比[aOR]：2.00，95%置信区间1.36-2.95，P = 0.001）或含氯吡格雷的治疗方案（aOR：1.77，1.16-2.70，P = 0.008）。地区差异包括：如果患者已在服用阿司匹林，来自欧洲的受访者较少选择多种药物（与美国/加拿大相比，aOR：0.57，0.35-0.93，P = 0.023），来自亚洲的受访者更常倾向于多种药物（aOR：1.95，1.11-3.43，P = 0.020），而来自美国/加拿大的受访者在伴有ILT时更倾向于选择含肝素的治疗方案（与其他地区相比，aOR：3.35，2.23-5.03，P < 0.001）。增加对≥2种抗血栓药物使用热情的因素包括多次短暂性脑缺血发作（57.2%）、ILT（58.5%）和溃疡性斑块（57.4%）；56.3%的人认为MRI微出血会降低使用热情。
结论
我们的结果凸显了对于热颈动脉最佳抗血栓治疗方案存在的异质性管理以及业界的权衡。
Zotero 插件