阿司匹林加用低分子肝素预防短暂性脑缺血发作和脑卒中的近期复发

目的:探索阿司匹林加用低分子肝素预防短暂性脑缺血发作(TIA)复发和脑卒中的作用。方法:对68例TIA患者随机分为单药治疗组33例和联合治疗组35例,两组均采用阿司匹林(ASA)0.3g·d-1、10d后改为0.1g·d-1,口服。联合治疗组加用低分子肝素(LMWH)(0.1mL·kg-1,皮下注射,q12h)。比较TIA复发率和脑梗死发生率的差异。结果:联合治疗组和单药治疗组比较,2周、3个月TIA复发率在联合治疗组差异有统计学意义(0:9.09%,2.86%:18.18%);3个月时脑梗死的发生率在联合治疗组差异也有统计学意义(5.71%:24.24%)。结论:结果提示ASA加用LMWH预防TIA复发和脑梗死发生的近期疗效优于单用ASA。     

低分子肝素治疗急性脑梗死35例临床观察

目的观察低分子肝素治疗急性脑梗死患者的疗效。方法应用低分子肝素治疗急性脑梗死35例，并与低分子右旋糖苷加复方丹参治疗组对照。结果低分子肝素治疗组疗效明显高于对照组（P〈0．01），无严重不良反应。结论旱期应用低分子肝素能明显提高急性脑梗死的疗效、改善病残程度。低分子肝素是治疗急性脑梗死安全简便有效的药物。     

低分子肝素钙防治短暂性脑缺血发作的观察

目的　观察低分子肝素钙防治短暂性脑缺血发作 (TIA)的疗效。方法　对 5 0例反复发作的TIA患者随机分为治疗组和对照组 ,分别给予低分子肝素钙及普通治疗。结果　治疗组比对照组治愈率 (P <0 0 5 )明显增高。结论　本疗法疗效理想 ,应用方便 ,不良反应极少 ,值得临床推广应用     

低分子肝素钙治疗短暂性脑缺血发作45例疗效观察

目的 :评价低分子肝素钙治疗短暂性脑缺血发作的疗效和安全性。方法 :入选 45例病例均采用低分子右旋糖酐作基础治疗 ,治疗组 2 6例发病 48h内短暂脑缺血发作病例 ,用低分子肝素钙 2 5 0 0AXaIU ,bid ,腹壁皮下注射 ,连续 7天。结果 :随访半年观察统计学显示治疗组TIA完全消失者 73 0 8% ,明显优于对照组 3 6 84% ;症状反复发作、发展完全卒中两组无差异。未发现出血倾向结论 :低分子肝素钙治疗短暂脑缺血发作是安全有效的     

降纤酶联合低分子肝素治疗短暂性脑缺血发作40例疗效观察

目的观察降纤酶联合低分子肝素治疗短暂性脑缺血发作（TIA）的疗效。方法将入选的80例TIA患者随机分为2组，对照组40例，采用复方丹参注射液20ml，胞二磷胆碱1．0g分别加入生理盐水250mi静滴，qd，连用2周；治疗组40例，采用降纤酶5U加生理盐水100ml静滴，低分子肝素5000U皮下注射，qd，连用2周。监测治疗前，治疗7d及2周结束时纤维蛋白原（Fg），凝血酶原时间（PT）；记录TIA发作减少次数及停止时间和不良反应。结果治疗组总有效率100％，对照组总有效率62．5％，治疗组显著高于对照组（P〈0．01）；Fg和PT与治疗前相比，差异均有统计学意义（P〈0．01）。结论降纤酶联合低分子肝素治疗TIA是一种安全有效的方法。     

低分子肝素治疗急性脑梗死疗效观察及对凝血功能的影响

目的　观察急性脑梗死患者低分子肝素的治疗效果及对凝血功能的影响。方法　将我院 1999年 6月～ 2 0 0 1年 3月住院的 134例急性脑梗死患者分成三组 ,治疗前及治疗后 7天、10天分别作血凝监测。同时对患者的神经系统功能缺损进行评分 ,并评价临床疗效。结果　大剂量低分子肝素组总有效率 89.1% ,小剂量低分子肝素组总有效率 83.7% ,对照组总有效率 5 7.8%。大、小剂量低分子肝素组疗效比较无显著性差异 (P >0 .0 5 ) ,低分子肝素组疗效与对照组比较有显著性差异 (P <0 .0 1)。三组用药前后血小板计数、出凝血指标无明显变化 ,大剂量低分子肝素组凝血酶原时间治疗后轻度延长 ,但无显著性差异。抗凝治疗早期出血率较高 ,较小强度的抗凝治疗出血率低于较大强度的抗凝治疗 ,未出现颅内出血这一并发症。结论　低分子肝素治疗急性脑梗死有效 ,特别是大剂量低分子肝素起效快 ,疗效好 ,远期疗效需做进一步临床观察     

低分子肝素治疗短暂性脑缺血发作50例疗效观察

目的 评价低分子肝素(LMWH)治疗短暂性脑缺血发作(TIA)的疗效.方法 将50例TIA患者随机分为治疗组和对照组各25例,治疗组给予LMWH 0.14ml(相当于4100anti-XaIU),腹壁脐旁皮下注射.对照组给予常规治疗.结果 治疗组显效率(76%)显著优于对照组(40%),P＜0.05.治疗组总有效率(96%)亦显著优于对照组(68%),P＜0.01.对照组发生脑梗死4例,而治疗组无1例恶化,有2例出现皮肤淤斑.结论 低分子肝素治疗TIA安全有效.     

降纤酶联合低分子肝素治疗短暂性脑缺血发作40例疗效观察

目的观察降纤酶联合低分子肝素治疗短暂性脑缺血发作(TIA)的疗效。方法将入选的80例TIA患者随机分为2组,对照组40例,采用复方丹参注射液20ml,胞二磷胆碱1.0g分别加入生理盐水250ml静滴,qd,连用2周;治疗组40例,采用降纤酶5U加生理盐水100ml静滴,低分子肝素5000U皮下注射,qd,连用2周。监测治疗前,治疗7d及2周结束时纤维蛋白原(Fg),凝血酶原时间(PT);记录TIA发作减少次数及停止时间和不良反应。结果治疗组总有效率100%,对照组总有效率62.5%,治疗组显著高于对照组(P<0.01);Fg和PT与治疗前相比,差异均有统计学意义(P<0.01)。结论降纤酶联合低分子肝素治疗TIA是一种安全有效的方法。     

低分子肝素钙并丹参川芎嗪注射液治疗老年短暂性脑缺血发作

目的探讨低分子肝素钙联合丹参川穹嗪注射液治疗老年短暂性脑缺血发作(TIA)的疗效。方法将92例短暂性脑缺血发作患者随机分为观察组和对照组各46例,对照组给予低分子肝素钙5000IU皮下注射,2次/d;观察组在给予低分子肝素的基础上加用丹参川芎嗪注射液治疗;比较2组间的治疗效果。结果治疗组总有效率89.1%(41/46),对照组67.4%(31/46),2组相比差异有统计学意义(P<0.05)。结论低分子肝素钙联合丹参川芎嗪注射液治疗老年短暂性脑缺血发作总有效率高,无明显不良反应,效果肯定。     

低分子肝素钙早期治疗ABCD2高评分值短暂性脑缺血发作疗效观察

目的 探讨低分子肝素钙早期治疗ABCD2高评分值短暂性脑缺血发作(TIA)患者的疗效.方法 按照Johns-ton等对TIA的ABCD2评分标准,测定218例TIA患者的分值,并根据分值分为低危组、中危组和高危组.然后在中危组和高危组随机分为治疗组和对照组.2组均给予基础治疗,治疗组在此基础上加低分子肝素钙腹壁皮下注射...     

低分子肝素治疗短暂性脑缺血发作的疗效观察

目的 探讨在抗血小板治疗基础下加用低分子肝素对短暂性脑缺血发作（TIA）的治疗效果。方法 对102例TIA患者进行前瞻性非随机对照研究。对照组54例，给予控制危险因素、阿司匹林50&#8197;mg、奥扎格雷钠160&#8197;mg，疗程7～10&#8197;d；治疗组48例，在上述治疗的基础上加用低分子肝素钠5000&#8197;U，每日两次脐周皮下注射，疗程7～10&#8197;d。两组在年龄、性别、分型（颈内动脉系统或椎基底动脉系统）、危险因素、每次症状持续时间以及到治疗时的发病次数均无统计学差异。结果 药物治疗30&#8197;d内，两组的疗效无统计学差异（Ｐ＞0.05）。随访3个月的结果示：两组间的卒中复发率（包括TIA、脑梗死）、心肌梗死发生率无统计学差异（Ｐ＞0.05）。治疗组2例齿龈出血，对照组无出血发生。结论 在抗血小板治疗基础上，加用低分子肝素未改善TIA治疗效果。     

Joint effects of risk factors for stroke and transient ischemic attack in a German population

BACKGROUND: Single, modifiable risk factors for stroke have extensively been studied. In contrast, differences of their combined effects among stroke and transitoy ischemic attack (TIA) have been rarely investigated. The aim of the present study was to assess single and joint effects of risk factors on the incidence of stroke and TIA and to compare their magnitudes in a large population-based German cohort. METHODS: Incident cases of stroke and TIA were identified among 25,538 participants (aged 35-65 at baseline) of the European Prospective Investigation into Cancer and Nutrition (EPIC)-Potsdam Study. Relative risks for stroke and TIA related to modifiable risk factors were estimated using Cox proportional hazard models. RESULTS: During 4.3 years of follow-up 100 stroke cases and 112 TIA cases occurred. Incidences of stroke and TIA were 91.7 and 102.7 per 100,000 person-years, respectively. Relative risks for ischemic stroke (RR 5.12, 95% CI 1.49-17.6, p for trend<0.0001) and for TIA (RR 3.08, 95% CI 1.00-9.44, p for trend<0.024) were highest among participants having 4 or 5 modifiable risk factors. 58.5% of ischemic strokes and 26.2% of TIA cases were attributable to the 5 risk factors hypertension, diabetes mellitus, high alcohol consumption, hyperlipidemia, and smoking. CONCLUSION: Our data indicate that classical risk factors may explain almost 60% of ischemic stroke but only one in four TIA cases. Analysing potential differences of known risk factors between ischemic stroke and TIAs and the identification of other determinants of ischemic attacks are important steps to better explain the burden of stroke.     

Risk factors and treatment of stroke at the time of recurrence

The profile of recurrent ischemic strokes has not been much investigated. The aim of this study was to evaluate how the therapeutic strategies recommended for secondary prevention after an ischemic stroke are implemented in the real world of clinical practice. All patients admitted for a recurrent ischemic stroke or TIA were prospectively registered. The etiology was determined according to the TOAST classification. The risk factors and cardiovascular treatment at the time of the recurrence were recorded. A total of 168 patients were evaluated. Most of the patients (61%) recurred after 1 year. The recurrent stroke was not associated with a particular etiological subtype. The most frequent risk factor was hypertension (79%), followed by hypercholesterolemia (43%), smoking (25%), and diabetes (22%). Most of the patients had more than 1 risk factor (84%). Hypertension was not satisfactorily controlled in 38% of patients, hypercholesterolemia in 42%, and diabetes in 59%. A significant minority of patients (15%) were not taking any antithrombotic agent despite a history of stroke or TIA. Only 34% of the cases with a known atrial fibrillation were on anticoagulant therapy and the International Normalized Ratio was < 2.0 in 71% of them. In conclusion, stroke prevention needs to be improved by better implementation of therapeutic strategies in clinical practice. The patients should also be better informed about target values as well as the importance of physical activity and smoking cessation.     

Clinical-CT correlations in TIA, RIND, and strokes with minimum residuum

An approach to the controversy of the physiopathology and classification of ischemic stroke is attempted in this study. The computed tomographies (CT) of 88 patients with transient ischemic attacks (TIA), 46 with reversible ischemic neurologic deficits (RIND) and 70 with ischemic strokes with minimum residuum (SMR) are analysed. The incidence of focal ischemic lesions on CT is 25% in TIA and RIND and 35% in SMR, when the study was performed after the first 24 hours. The incidence of cerebral infarction was much lower when the CT was performed within the first 24 hours after the clinical event. No significant differences in size or location of the infarction were found between the different groups. Deep infarctions were smaller than superficial ones. TIA duration correlated neither with the incidence of CT abnormalities nor with the size of the lesions. No correlation was found between doppler or oculoplethysmography abnormalities, clinical groups and CT findings. In reference to the structural lesions that underlie the clinical syndromes, TIA, RIND and SMR should not be considered as different groups.     

Do antiphospholipid antibodies increase the long‐term risk of thrombotic complications in young patients with a recent TIA or ischemic stroke?

BACKGROUND: The purpose of our study was to determine the relative risk of thrombotic events in young patients with a recent TIA or ischemic stroke and positive antiphospholipid antibodies (aPL). METHODS: We included 128 consecutive patients aged 18-45 years with a recent TIA or ischemic stroke. All patients underwent computed tomography scanning and were screened for cardiovascular risk factors, cardiac disorders and large vessel disease. Lupus anticoagulant (LA) was screened for by an APTT-based assay and a diluted PT-assay. Anticardiolipin antibodies (aCL) were tested by enzyme-linked immunosorbent assay, using cardiolipin and anti-human IgG and IgM. Thrombotic events could be TIA, stroke, myocardial infarction, deep venous thrombosis or pulmonary embolism. Product limit estimates of the time free of TIA or stroke and of the time free of any thrombotic event were made. The relative risk was estimated by means of a Cox proportional hazards regression model. RESULTS: Of the 128 patients, 22 (17.2%) had aPL. The mean follow-up was 3 years and 3 months (range 41 days to 6 yrs). The incidence of any thrombotic event per 100 patient years of follow-up was 9.0, and the incidence of recurrent stroke or TIA was 7.9. The relative risk of any thrombotic event in patients with aPL was 0.9 (95% CI: 0.3-2.4) and for recurrent ischemic stroke or TIA 0.7 (95% CI: 0.3-2.2). CONCLUSION: In young patients with a recent TIA or ischemic stroke, aPL do not seem to be a strong risk factor for recurrent stroke or TIA, nor for other thrombotic complications.     

Relevance of transient ischemic attack to early neurological recovery after nonlacunar ischemic stroke

BACKGROUND: We hypothesized that previous transient ischemic attack (TIA) had a favorable effect on early outcome after acute nonlacunar ischemic stroke. METHODS: Data of 1,753 consecutive patients with ischemic stroke collected from a prospective hospital-based stroke registry were studied. A comparison was made of the groups with and without previous TIA. Favorable outcome included spontaneous neurological recovery or grades 0-2 of the modified Rankin scale at hospital discharge. RESULTS: Previous TIA occurred in 55 (11.5%) of 484 patients with lacunar stroke and in 166 (13.1%) of 1,269 patients with nonlacunar stroke. The percentage of nonlacunar ischemic stroke patients with favorable outcome was 21.7% in those with a history of TIA compared to 15% without TIA (p < 0.03). In the lacunar stroke group, differences were not significant. In the multivariate analysis, TIA was an independent predictor of spontaneous in-hospital recovery. CONCLUSIONS: Prior TIA was associated with a favorable outcome in nonlacunar ischemic stroke, suggesting a neuroprotective effect of TIA possibly by inducing a phenomenon of ischemic tolerance allowing better recovery from a subsequent ischemic stroke.     

Impact of abnormal diffusion-weighted imaging results on short-term outcome following transient ischemic attack

OBJECTIVE: To characterize short-term prognoses among patients with transient ischemic attack (TIA) and normal diffusion-weighted imaging (DWI) results, TIA patients with abnormal DWI results (transient symptoms associated with infarction [TSI]), and patients with completed ischemic stroke (IS). DESIGN: Retrospective study. SETTING: University hospital. PATIENTS: We reviewed patient medical records between January 2003 and December 2004 with International Classification of Diseases, Ninth Revision codes for TIA at admission, resolution of neurological symptoms within 24 hours, magnetic resonance imaging within 48 hours, and a discharge diagnosis of TIA or IS. A random sample of 50 IS patients was selected from all IS admissions and discharges by International Classification of Diseases, Ninth Revision codes. Demographic, clinical, radiographic, and in-hospital outcome data were recorded. Three diagnostic categories were created: TIA with normal DWI results, TSI, and IS. Multivariate logistic regression was used to estimate the association between diagnostic category and rate of in-hospital stroke or recurrent TIA among the 3 groups. RESULTS: We identified 146 classic TIA (25% with TSI) and 50 IS cases. There were 4 recurrent TIAs and 6 strokes among patients with TSI (27.0%); 3 recurrent TIAs and no strokes among patients with normal DWI results (2.8%); and 1 recurrent stroke and no TIAs among IS patients (2.0%). Transient symptoms associated with infarction was independently associated with in-hospital recurrent TIA or stroke (adjusted odds ratio, 11.2; P < .01). CONCLUSIONS: Transient symptoms associated with infarction is associated with a greater rate of early recurrent TIA and stroke than both IS and TIA with normal DWI results. These data suggest that TSI may be a separate clinical entity with unique prognostic implications.     

Clinical features and long-term follow-up of patients with reversible ischemic attacks (RIA)

The clinical features of 102 cases with transient attacks due to cerebral ischemia were evaluated, and 94 out of 102 cases were followed for an average of 6 years.
1) the clinical study makes comparisons between two groups of patients grouped under the somewhat new definition of Reversible Ischemic Attacks (RIA): classical Transient Ischemic Attacks (TIA) and Stroke with Full Recovery (SFR), in which a complete recovery took place over a longer period, on the average 3 weeks.
2) SFR constitutes the 34.31% of the total cases with transient ischemic episodes. In the carotid district the onset was more frequently gradual in SFR than in TIA and aphasia more frequent in TIA than in SFR. Multiple attacks prevailed in TIA over the SFR group. the definition of transient attack due to ischemia is discussed.
3) Completed strokes occurred in 11 cases (11.7%) with RIA. Hypertension and cardiac disease were significantly frequent in cases with subsequent stroke.
The conclusion was reached that TIA is a symptom, not a pathological state, and TIA should be considered an important symptom but not a specific harbinger of completed stroke.     

Dabigatran for Japanese Patients with Atrial Fibrillation and Prior Stroke: A Subgroup Analysis of the J-Dabigatran Surveillance Program

Background: The study objective was to evaluate long-term safety and effectiveness of dabigatran 110 mg and 150 mg twice daily (bid) in patients with nonvalvular atrial fibrillation (NVAF) with a focus on secondary stroke prevention. Methods: In J-Dabigatran Surveillance, 6772 patients newly initiated on dabigatran to prevent ischemic stroke and systemic embolism were enrolled in Japan (1042 sites, December 2011 to November 2013). This subgroup analysis included patients with (1302) and without (5071) previous stroke/transient ischemic attack (TIA). Case report forms were reviewed to determine incidence of outcome events. Results: In patients with previous stroke/TIA, the incidence rate for recurrent stroke/TIA was 2.48/100 patient-years (ischemic stroke 2.22, hemorrhagic stroke 0.18, TIA 0.12) and for major bleeding was 1.79/100 patient-years, including intracranial bleeding (0.55). Event rates for recurrent stroke/TIA or major bleeding were 1.2% (for both) for patients who started dabigatran less than 30 days after stroke onset and 0.3% (for both) for patients who started dabigatran more than or equal to 30 days after stroke onset, and were independent of dabigatran dose. For patients with previous stroke/TIA, 17% who received 110 mg bid did not meet dose reduction recommendations (DRRs) and 28% who received 150 mg bid met at least 1 DRR, but the dabigatran dose was not reduced. Use of DRRs did not have a major impact on the incidence rates of recurrent stroke/TIA and major bleeding. Conclusion: Findings from this subgroup analysis support the real-world safety and effectiveness of long-term dabigatran in Japan, particularly for patients with NVAF in secondary prevention settings.