The Many Roles of Statins in Ischemic Stroke

Stroke is the third leading cause of human death. Endothelial dysfunction, thrombogenesis, inflammatory and oxidative stress damage, and angiogenesis play an important role in cerebral ischemic pathogenesis and represent a target for prevention and treatment. Statins have been found to improve endothelial function, modulate thrombogenesis, attenuate inflammatory and oxidative stress damage, and facilitate angiogenesis far beyond lowering cholesterol levels. Statins have also been proved to significantly decrease cardiovascular risk and to improve clinical outcome. Could statins be the new candidate agent for the prevention and therapy in ischemic stroke? In recent years, a vast expansion in the understanding of the pathophysiology of ischemic stroke and the pleiotropic effects of statins has occurred and clinical trials involving statins for the prevention and treatment of ischemic stroke have begun. These facts force us to revisit ischemic stroke and consider new strategies for prevention and treatment. Here, we survey the important developments in the non-lipid dependent pleiotropic effects and clinical effects of statins in ischemic stroke.     

Role of antiplatelet therapy in cardiovascular disease II: Ischemic stroke

The etiology of cerebrovascular disease is heterogeneous, with the majority of strokes being of ischemic origin. Transient ischemic attack is now considered to be an important precursor and long-term risk factor for ischemic stroke. Given the lack of acute therapies for ischemic stroke, current

treatments focus on secondary prevention through risk-factor management, pharmacotherapy and interventional approaches. As illustrated in this paper, antiplatelet agents (e.g. clopidogrel, aspirin, dipyridamole) are the cornerstone of therapy for prevention of recurrent ischemic stroke.     

蚓激酶或阿司匹林预防脑梗死复发的疗效分析

目的探讨长期服用蚓激酶或小剂量阿司匹林对脑梗死复发的预防作用。方法对127例脑梗死患者进行回顾性调查,分别统计分析42例(观察组)长期服用蚓激酶(22例,一日120~180U,服药时间>150 d)或小剂量肠溶阿司匹林(20例,一日50~70 mg,服药时间>150 d)的患者及85例(对照组)未正规服用抗凝药物患者的脑梗死复发率。结果脑梗死复发率观察组为9.52%,对照组为30.58%,前者明显低于后者(P<0.05)。结论长期服用蚓激酶或小剂量肠溶阿司匹林对脑梗死复发有一定的预防作用。     

心房颤动患者近期缺血性卒中后应用依多沙班抗凝治疗的时机和剂量的研究进展

心房颤动（Atrial fibrillation,AF）是成人中常见的持续性心律失常,给医疗保健增加巨大负担。心律失常不仅与生活质量下降和频繁住院有关,而且与缺血性卒中、其他血栓栓塞事件和死亡率增加的风险增加有关。AF患者的缺血性卒中风险因个体风险状况而异,不使用口服抗凝剂（Oral anticoagulant,OAC）的缺血性卒中发生率约为3.20/100人年。与其他卒中病因相比,AF相关卒中患者的预后更差。所有AF患者都必须实施个体卒中风险评估和使用最佳卒中预防策略。依多沙班的适应证是预防AF患者的卒中,该药口服给药,剂量为60 mg,每日1次。本文讨论了AF患者近期缺血性卒中后应用依多沙班抗凝治疗的时机和剂量的研究进展。     

缺血性脑卒中发病影响因素的研究

目的:探讨缺血性脑卒中发病的影响因素,为预防和控制缺血性脑卒中的发生和发展提供科学依据。方法:采用1∶1配比进行对比研究,收集病例和对照各206例,调查研究对象的既往病史、家族史、环境因素等资料,采用SP SS 13.0统计软件对研究因素进行L og istic回归分析。结果:体育锻炼为缺血性脑卒中的保护性因素,OR值为0.116;高血压、高血糖、体重指数(BM I)和吸烟为缺血性脑卒中发病的危险因素,OR值分别为5.392,2.768,3.568,4.826。结论:及时防治高血压和糖尿病等原发病,积极控制体重和吸烟,养成良好的生活方式是预防和控制缺血性脑卒中的最有效的措施。     

Antithrombotic treatment in the prevention of ischemic stroke

Approximately 5.7 million people died from stroke in 2005 [1]. According to World Health Organization estimates, figures are predicted to increase to 23 million first-ever strokes, 77 million stroke survivors, 61 million disability adjusted life years (DALYs) and 7.8 million deaths in the next 20 years [2]. Heart disease and stroke are leading causes of DALYs lost and deaths worldwide [3]. Over 70 % of ischemic strokes are first events, which makes primary prevention immensely important. The treatments for acute ischemic stroke have emerged during the last decade and there is growing evidence of efficacy and importance of secondary prevention. We foresee that patients at high risk of vascular events could reduce their risk by 75 to 80 % through optimal prevention strategies including a combination of lifestyle changes and medical therapy [4]. In this review, we will focus on the aspects of antithrombotic treatment of ischemic stroke (IS) in the primary and secondary prevention.     

中药用于治疗缺血性脑卒中的几个问题

本文对近年来中药在缺血性脑卒中治疗中的应用情况进行了回顾,认为中药用于治疗和预防缺血性脑卒中有一定的实验和临床依据。今后更应当注重于脑卒中二级预防的研究和证据的积累,以期为临床应用提供更可靠的证据。     

阿托伐他汀联合抗血小板药治疗缺血性脑卒中的研究进展

目的探讨阿托伐他汀联合抗血小板药治疗缺血性脑卒中患者的疗效与安全性。方法查阅文献,综合论点。结果我国人群中脑卒中患者以缺血性为主,他汀类药物和抗血小板药根据不同的药理机制与脑卒中的一、二级预防有着紧密的联系,结论两者在缺血性脑卒患者中联合使用取得了比单一使用更好的疗效,本文就该种疗法的应用进行综述。     

Drug evaluation of clopidogrel in patients with ischemic stroke

Clopidogrel is an effective antiplatelet medication used for the secondary prevention of ischemic events in patients with various cardiovascular, cerebrovascular and peripheral vascular disease conditions. The objective of this paper is to discuss the role of clopidogrel in ischemic stroke patients and to review the existing data from randomized trials supplemented by pilot and mechanistic studies that supports these indications for its use. An analysis of the mechanism of action and pharmacology of clopidogrel is provided. After Phase III trials, such as the CAPRIE (Clopidogrel versus Aspirin in Patients at Risk of Ischemic Events) and MATCH (Management of Atherothrombosis with Clopidogrel in High-risk patients) trials, the role of clopidogrel in secondary prevention is well defined. The role of clopidogrel in acute ischemic stroke and neurointerventional procedures is evolving based on new pilot trials. At present, there is insufficient data to recommend the use of clopidogrel in acute ischemic stroke. Clopidogrel may be a valuable alternative to aspirin. However, more studies are required to assess the role of clopidogrel in selected patient groups with respect to acute ischemic stroke.     

Drug evaluation of clopidogrel in patients with ischemic stroke

Clopidogrel is an effective antiplatelet medication used for the secondary prevention of ischemic events in patients with various cardiovascular, cerebrovascular and peripheral vascular disease conditions. The objective of this paper is to discuss the role of clopidogrel in ischemic stroke patients and to review the existing data from randomized trials supplemented by pilot and mechanistic studies that supports these indications for its use. An analysis of the mechanism of action and pharmacology of clopidogrel is provided. After Phase III trials, such as the CAPRIE (Clopidogrel versus Aspirin in Patients at Risk of Ischemic Events) and MATCH (Management of Atherothrombosis with Clopidogrel in High-risk patients) trials, the role of clopidogrel in secondary prevention is well defined. The role of clopidogrel in acute ischemic stroke and neurointerventional procedures is evolving based on new pilot trials. At present, there is insufficient data to recommend the use of clopidogrel in acute ischemic stroke. Clopidogrel may be a valuable alternative to aspirin. However, more studies are required to assess the role of clopidogrel in selected patient groups with respect to acute ischemic stroke.     

《2021 AHA/ASA指南:卒中和短暂性脑缺血发作患者的卒中预防》解读

2021年5月24日,美国心脏协会和美国卒中协会(AHA/ASA)发布《2021AHA/ASA指南:卒中和短暂性脑缺血发作患者的卒中预防》。该指南内容涉及继发性卒中预防的诊断评估、血栓风险因素的管理、病因学管理以及继发性卒中的系统护理等。该文拟对指南中药物治疗相关部分进行解读,并对抗栓药物与既往版本指南进行比较,以期为我国缺血性卒中和短暂性脑缺血发作生存者卒中的二级预防提供参考。     

Antiplatelet therapy for secondary prevention in stroke � making the right choice

In 2004, approximately 9 million people worldwide experienced a stroke, with the majority being ischemic in nature. While the prognosis for recovery can be good, long-term survival and functional outcome can be improved. Stroke survivors are at an increased risk for recurrent stroke and other ischemic vascular events and face significant cross-risk for atherothrombotic conditions affecting the coronary and peripheral vascular beds. As such, the secondary prevention of ischemic events in patients with stroke has focused on the treatment of atherosclerosis as a whole, with antiplatelet therapy playing a key role. There is some controversy regarding optimal antiplatelet therapy following stroke. The appropriate use of specific agents, the impact of stroke type and proper dosing, and other questions stem from an incomplete understanding of the issues, variability in clinical trial data, diversity in patient demographics, and differences in antiplatelet regimens. This review evaluates the clinical evidence for antiplatelet therapy in patients that have suffered an ischemic stroke, with an emphasis on balancing the benefits of a particular antiplatelet regimen with its attendant risk profile. The critical assessment of emerging trial data and its impact on existing treatment guidelines may aid in choosing the most appropriate antiplatelet regimen for comprehensive secondary prevention following stroke.     

Antiplatelet therapy in cerebrovascular disorders

Antiplatelet treatment is a mainstay in acute and long-term secondary stroke prevention. Aspirin is still most widely used worldwide, however, there is increasing evidence from small randomised trials that dual antiplatelet therapy combining aspirin with dipyridamole or clopidogrel might be more effective in the acute and early chronic post-ischemic phase (i.e. first 90 days). Both clopidogrel and the combination of aspirin and extended-release dipyridamole are recommended by current guidelines in long-term secondary stroke prevention in patients who are at high risk for a recurrent ischemic stroke, since they are more effective compared with aspirin monotherapy.Antiplatelet agents are the therapy of choice in patients with ischemic stroke due to intracranial stenosis and patent foramen ovale. In contrast, oral anticoagulation is clearly superior to single or double antiplatelet therapy in patients with cardioembolic stroke, mainly caused by atrial fibrillation.Concerning newer antiplatelet agents, only cilostazol appears to be a promising therapeutic option in patients with ischemic stroke in the near future, but so far, only studies in Asian stroke patients have been performed.     

Antithrombotic drug treatment of pediatric patients with ischemic stroke

Causes of stroke in children include congenital heart malformations, sickle cell disease, infections, and metabolic disorders. Up to 80% of children with ischemic stroke have cerebrovascular disease, and case control studies demonstrate an association of ischemic stroke in children with hereditary prothrombotic risk factors. There have been no randomized, clinical trials for primary prevention, short-term treatment, or secondary prevention of pediatric ischemic stroke. Treatment recommendations are based on small case series or case reports, and have mainly been adapted from adult stroke studies. Antiplatelet agents (e.g. aspirin [acetylsalicylic acid]) and heparins (e.g. low molecular weight heparin), have been used on an individual patient basis. Warfarin is administered in children with cardioembolic stroke, arterial dissection, or persistent hypercoagulable states. Alteplase has been used in a few patients within 3 hours of the onset of symptoms. In each patient treated the benefit of anticoagulation has to be weighed up against the individual bleeding risk.     

新型口服抗凝药在非瓣膜性房颤合并脑血管病中的研究进展

抗凝治疗被认为是非瓣膜性心房颤动(房颤)患者缺血性卒中预防策略的基石。新型口服抗凝药相较于传统口服抗凝药华法林, 具有起效快、半衰期短、药物相互作用少以及无需频繁监测凝血指标等优点, 被普遍应用于预防治疗中, 大幅降低了非瓣膜性房颤患者缺血性卒中的发生风险。但对于合并颅内动脉粥样硬化狭窄、急性缺血性卒中、颅内出血、颅内微出血等增加卒中及出血风险的非瓣膜性房颤患者, 临床抗凝治疗及启动时间的选择无疑是个挑战。本文将对新型口服抗凝药在合并常见脑血管病的非瓣膜性房颤患者中的应用进行综述, 为临床治疗与预防提供参考。     

他汀类药物在缺血性卒中及短暂性脑缺血发作二级预防中的作用

目的对他汀类药物在缺血性卒中及短暂性脑缺血发作二级预防中的作用进行评价分析,为今后的临床预防以及合理用药工作提供可靠的参考依据。方法 抽取在2010年1月至2012年12月间本院收治的缺血性卒中/短暂性脑缺血发作患者218例,将其按照病情程度分成高危组、极高危Ⅱ组、极高危Ⅰ组,对这三组患者入院后与随访3个月的临床用药情况进行统计分析。结果本组218例患者中在住院期间预防性应用他汀类药物者115例,应用率为52.75%,其中极高危Ⅰ组他汀类药物应用与指南的符合率较高危组与极高危Ⅱ组高(P<0.05);随访3个月后,他汀类药物应用者为49例,应用率为22.48%,较住院期间发生显著降低(P<0.05)。结论在预防缺血性脑卒中和短暂性脑缺血发作时他汀类药物发挥了重要作用,降低了复发率,然其二级预防中用药依从性较差,与应用指南符合率较低,临床应予以注意,做好预防工作,合理用药,以改善患者预后。     

Dietary antioxidants as potential pharmacological agents for ischemic stroke

Acute ischemic stroke is a leading cause of death and severe disability in industrialised countries and also in many developing countries. An excessive amount of free radicals is generated during cerebral ischemia, which significantly contributes to brain damage. Therefore, an increasing interest has been devoted to the potential benefits of antioxidant compounds in ischemic stroke patients. In this review, we examined the most relevant observational studies concerning the relationship between dietary antioxidants and ischemic stroke as well as clinical trials investigating the effects of single or multiple antioxidant supplementation in the prevention or treatment of acute ischemic stroke. Furthermore, we reviewed the most promising antioxidant compounds, i.e. dehydroascorbic acid, alpha-tocotrienol, gamma-tocopherol, flavonoids, resveratrol and gingko biloba, tested in animal models of acute ischemic stroke. Finally, we carefully evaluated the reasons for the discrepancy between experimental and clinical studies, and provided recommendations to improve the translation of the results obtained in animal models to patients with acute ischemic stroke.     

Primary and secondary stroke prevention with antiplatelet drugs

Aspirin is not effective in the primary prevention of stroke. Patients with TIA or ischemic stroke carry a risk of recurrent stroke between 5 and 20% per year. In patients with TIA or ischemic stroke of noncardiac origin antiplatelet drugs are able to decrease the risk of stroke by 11-15% and the risk of stroke, MI and vascular death by 15-22%. Aspirin is the most widely used drug. It is affordable and effective. Low doses of 50-325 mg aspirin are as effective as high doses and cause less gastrointestinal side effects. Severe bleeding complications are dose-dependent. The combination of aspirin with slow release dipyridamole is superior to aspirin alone for stroke prevention. Clopidgrel is superior to aspirin in patients at high risk of recurrence. The combination of aspirin plus clopidogrel is not more effective than clopidogrel alone but carries a higher bleeding risk. None of the antiplatelet agents is able to reduce mortality.     

口腔医院门诊处方合理用药国际指标调研及分析

目的了解我院门诊处方合理用药状况,为实施不合理用药的干预提供参考。方法对我院2008年7月全部门诊处方进行合理用药国际指标的调研和分析。结果不用药物治疗的患者占77．47％;平均用药品种数1．60种;抗菌药物使用率15．22％,占总药费的14．83％;注射剂使用率65．47％,占总药费的13．11％;基本药物使用率75．61％,占总药费的42．59％;北京市医保药品使用率97．65％,占总药费的94．44％;通用名使用率99．95％;平均处方金额43．74元。结论我院门诊处方用药基本合理,但基本药物的使用率仍有待提高。