Department of Clinical Neurosciences, Stroke Centre, Neurology Service (J.P.M., D.S., P.M.), Lausanne University Hospital, Switzerland.
Department of Neurology, Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal (J.P.M.).
Stroke. 2021 Oct;52(10):e646-e659. doi: 10.1161/STROKEAHA.120.033272. Epub 2021 Aug 18.
Certain drugs may increase the risk of ischemic stroke (IS). Our goal was to review associations between frequently used drugs and IS. We created an initial list of frequently used drugs to search Pubmed/MEDLINE from 1966 to 2020 and reviewed phase III and IV data, case series, and drug authorities' safety warnings to assess a potential association with IS. Drugs were grouped according to the World Health Organization Anatomical Therapeutic Chemical Classification System. Predefined criteria were applied to establish a level of evidence for an association, from A (high level of evidence of association) to E (high level of evidence of absence of association). In addition, we assessed relative risks and reviewed potential mechanisms of IS facilitation. We assessed 81 drugs or drug classes from 11 World Health Organization Anatomical Therapeutic Chemical Groups. We identified a high level of association for erythropoietin, combined contraceptives, oral estrogen replacement therapy, bevacizumab, tamoxifen, and antipsychotics and a moderate level for ponatinib, nilotinib, darunavir, and gonadotropin-releasing hormone agonists. Drug dose and treatment duration may modify the risk. For a substantial number of drugs, we found no association, and for others, there were insufficient data to categorize risk. We identified a high level of association of IS with a limited number of drugs, a potential association with some, and a lack of data for others. The summarized information may help clinicians to estimate the contribution of a drug to an IS, to better assess drug benefit-risk ratios, and to support decisions about using specific drugs.
某些药物可能会增加缺血性中风（IS）的风险。我们的目标是回顾常用药物与 IS 之间的关联。我们创建了一个常用药物的初始列表，以搜索 1966 年至 2020 年的 Pubmed/MEDLINE，并审查了 III 期和 IV 期数据、病例系列和药物当局的安全警告，以评估与 IS 相关的潜在关联。药物根据世界卫生组织解剖治疗化学分类系统进行分组。根据既定标准评估与 IS 相关的证据水平，从 A（高度关联证据）到 E（高度无关联证据）。此外，我们评估了相对风险，并审查了 IS 促进的潜在机制。我们评估了来自 11 个世界卫生组织解剖治疗化学组的 81 种药物或药物类别。我们确定了促红细胞生成素、联合避孕药、口服雌激素替代疗法、贝伐单抗、他莫昔芬和抗精神病药的高度关联，以及泊那替尼、尼洛替尼、达鲁纳韦和促性腺激素释放激素激动剂的中度关联。药物剂量和治疗持续时间可能会改变风险。对于大量药物，我们没有发现关联，对于其他药物，没有足够的数据来分类风险。我们确定了与少数几种药物的高度关联、与某些药物的潜在关联以及对其他药物缺乏数据。总结的信息可能有助于临床医生估计药物对 IS 的贡献，更好地评估药物的获益-风险比，并支持使用特定药物的决策。
