Stroke:治疗不明原因栓塞性中风,阿司匹林与利伐沙班疗效相似,且更安全

2019-08-21 朱柳媛 中国循环杂志

近日,Stroke杂志发表的NAVIGATE ESUS研究最新结果表明,对于存在颈动脉斑块或狭窄的不明原因栓塞性中风患者来说,阿司匹林(100 mg/d)和利伐沙班(15 mg/d)在预防中风复发方面疗效相似,但阿司匹林更安全。

近日,Stroke杂志发表的NAVIGATE ESUS研究最新结果表明,对于存在颈动脉斑块或狭窄的不明原因栓塞性中风患者来说,阿司匹林(100 mg/d)和利伐沙班(15 mg/d)在预防中风复发方面疗效相似,但阿司匹林更安全。

该研究显示,中位随访11个月期间,在存在颈动脉狭窄的不明原因栓塞性中风患者中,利伐沙班组和阿司匹林组的缺血性中风复发率分别为5例/百人年和5.9例/百人年,无明显组间差异。

在有颈动脉斑块的患者中,利伐沙班组和阿司匹组的缺血性中风复发率也同样相似,分别为5.9例/百人年和4.9例/百人年,但利伐沙班组的大出血发生风险是阿司匹林组的3.75倍(2例/百人年 vs 0.5例/百人年,HR=3.75)。

研究者指出,在有或无颈动脉斑块或狭窄的患者中,阿司匹林或利伐沙班的疗效均无明显差别。

在有或无颈动脉狭窄的患者中,缺血性中风的复发率无明显差别;但有颈动脉斑块的患者中缺血性中风的复发率高于无颈动脉斑块的患者。

研究者发现,颈动脉斑块在缺血性中风的同侧更常见,说明颈动脉斑块在不明原因栓塞性中风的发生中发挥重要的作用。

在NAVIGATE ESUS研究纳入的不明原因栓塞性中风患者中,40%的患者有颈动脉斑块,11%存在轻度颈动脉狭窄(狭窄程度20%~49%)。

原始出处:Ntaios G1, Swaminathan B2, Berkowitz SD3, et al. Efficacy and Safety of Rivaroxaban Versus Aspirin in Embolic Stroke of Undetermined Source and Carotid Atherosclerosis. Stroke. 12 Aug 2019

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  1. [GetPortalCommentsPageByObjectIdResponse(id=371634, encodeId=d1713e163472, content=好, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6d551998554, createdName=1e1c07bdm01(暂无匿称), createdTime=Thu Aug 22 05:53:09 CST 2019, time=2019-08-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1032258, encodeId=0e2c103225878, content=谢谢梅斯提供这么好的信息,学到很多, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=内科新手, createdTime=Thu Aug 22 02:15:00 CST 2019, time=2019-08-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1045885, encodeId=f139104588508, content=中风是俗称,应该称为缺血性卒中吧, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=guging, createdTime=Thu Aug 22 02:15:00 CST 2019, time=2019-08-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=371628, encodeId=23553e1628e7, content=学习了,谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220115/46bcf39c32de4aa6b45c5f9d66c8ee77/6cb4a20c55bb4b7691122f47747bfca2.jpg, createdBy=9dad1662329, createdName=1ddf0692m34(暂无匿称), createdTime=Wed Aug 21 23:37:56 CST 2019, time=2019-08-21, status=1, ipAttribution=)]
  2. [GetPortalCommentsPageByObjectIdResponse(id=371634, encodeId=d1713e163472, content=好, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6d551998554, createdName=1e1c07bdm01(暂无匿称), createdTime=Thu Aug 22 05:53:09 CST 2019, time=2019-08-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1032258, encodeId=0e2c103225878, content=谢谢梅斯提供这么好的信息,学到很多, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=内科新手, createdTime=Thu Aug 22 02:15:00 CST 2019, time=2019-08-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1045885, encodeId=f139104588508, content=中风是俗称,应该称为缺血性卒中吧, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=guging, createdTime=Thu Aug 22 02:15:00 CST 2019, time=2019-08-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=371628, encodeId=23553e1628e7, content=学习了,谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220115/46bcf39c32de4aa6b45c5f9d66c8ee77/6cb4a20c55bb4b7691122f47747bfca2.jpg, createdBy=9dad1662329, createdName=1ddf0692m34(暂无匿称), createdTime=Wed Aug 21 23:37:56 CST 2019, time=2019-08-21, status=1, ipAttribution=)]
    2019-08-22 内科新手

    谢谢梅斯提供这么好的信息,学到很多

    0

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    2019-08-22 guging

    中风是俗称,应该称为缺血性卒中吧

    0

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    2019-08-21 1ddf0692m34(暂无匿称)

    学习了,谢谢分享

    0

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