Xu Yu-Yuan, Gu Hong-Qiu, Li Zi-Xiao, Xiong Yun-Yun, Zhou Qi, Liu Li-Ping, Zhao Xing-Quan, Wang Yi-Long, Meng Xia, Wang Yong-Jun
China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Ann Transl Med. 2021 Apr;9(8):626. doi: 10.21037/atm-20-7902.
It is unknown about the influence of prestroke antiplatelet use on early outcomes in patients with and without the indication. We aimed to evaluate the in-hospital prognosis of first-ever noncardiogenic ischemic stroke patients with and without indications of antiplatelet use for primary prevention.
This was a retrospective, observational study based on a prospective hospital-based registry (Chinese Stroke Center Alliance). Using the data with 436,660 first-ever noncardiogenic acute ischemic strokes recorded from Aug 1, 2015, to July 31, 2019, from 1,453 hospitals in China, we examined the associations between the indication for prestroke antiplatelet use and in-hospital clinical outcomes.
Among 436,660 first-ever noncardiogenic ischemic stroke patients, 42,409 patients (9.7%) had a documented previous vascular indication and 394,251 (90.3%) did not. Compared to those without, patients with the indication were associated with increased prevalence of in-hospital morbid conditions, including stroke severity (OR 2.71; 95% CI: 2.62-2.81; P<0.0001), length of stay >14 days (OR 1.16; 95% CI: 1.13-1.19; P<0.0001), mortality (OR 2.20; 95% CI: 1.96-2.46, P<0.0001), and recurrence of ischemic stroke and transient ischemic attack (TIA) (OR 1.5; 95% CI: 1.43-1.59, P<0.0001). Among patients without indication, prestroke antiplatelet use was associated with lower mortality (OR 0.73, 95% CI: 0.56-0.96; P=0.0221); while among patients with indication, those receiving prestroke antiplatelet had lower odds ratios in stroke severity (P<0.0001) and disability (P=0.0003) than those who not.
Patients with indications of prestroke antiplatelet use were more likely to have unfavorable outcomes than those without. Prestroke antiplatelet might be associated with lower mortality, less disability, and less stroke severity in certain population groups. Future studies to improve risk prediction rules are needed to guide effective primary prevention for ischemic stroke.
卒中前使用抗血小板药物对有适应证和无适应证患者早期预后的影响尚不清楚。我们旨在评估首次发生的非心源性缺血性卒中患者在有和无一级预防抗血小板药物使用适应证情况下的住院预后。
这是一项基于前瞻性医院登记系统（中国卒中中心联盟）的回顾性观察研究。利用2015年8月1日至2019年7月31日期间中国1453家医院记录的436,660例首次发生的非心源性急性缺血性卒中数据，我们研究了卒中前抗血小板药物使用适应证与住院临床结局之间的关联。
在436,660例首次发生的非心源性缺血性卒中患者中，42,409例（9.7%）有既往血管疾病适应证记录，394,251例（90.3%）没有。与无适应证患者相比，有适应证患者住院期间合并症的患病率更高，包括卒中严重程度（比值比2.71；95%置信区间：2.62 - 2.81；P<0.0001）、住院时间>14天（比值比1.16；95%置信区间：1.13 - 1.19；P<0.0001）、死亡率（比值比 2.20；95%置信区间：1.96 - 2.46，P<0.0001）以及缺血性卒中和短暂性脑缺血发作（TIA）复发（比值比1.5；95%置信区间：1.43 - 1.59，P<0.0001）。在无适应证患者中，卒中前使用抗血小板药物与较低的死亡率相关（比值比0.73，95%置信区间：0.56 - 0.96；P = 0.0221）；而在有适应证患者中，卒中前接受抗血小板治疗的患者在卒中严重程度（P<0.0001）和残疾程度（P = 0.0003）方面的比值比低于未接受治疗的患者。
有卒中前抗血小板药物使用适应证的患者比无适应证患者更有可能出现不良结局。卒中前使用抗血小板药物可能与特定人群较低的死亡率、较少的残疾和较轻的卒中严重程度相关。需要进一步研究改进风险预测规则，以指导缺血性卒中的有效一级预防。
