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.     

缺血性脑卒中药物治疗的一些进展

本文介绍防治缺血性脑卒中的几类主要药物。重点介绍抗血栓药，包括溶栓药、抗凝药及抗血小板药在目前临床应用的情况；并简要介绍神经保护药、降脂药、降压药以及新提出的一些可能有效药物，如基于抗炎症的药物及基因治疗的研究进展。     

缺血性脑卒中的药物治疗

<正> 脑卒中发病主要有3方面的原因:脑血管的异常;血液学异常;血液动力学的异常。本文重点对缺血性脑卒中的药物治疗进行讨论。1 抗血小板治疗在病理情况下,血液中存在着各种使血小板活化的因素。卒中患者或卒中高危个体(如高血压、动脉粥样硬化、糖尿病等情况)体内存在着诸多激     

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.     

他汀类药物联合阿司匹林治疗急性缺血性脑卒中的疗效分析

目的探讨他汀类药物联合阿司匹林治疗急性缺血性脑卒中的临床疗效。方法选取2014年7月~2016年1月笔者所在医院收治的急性缺血性脑卒中患者84例,随机将患者分观察组与对照组,每组各42例。对照组患者采用肠溶阿司匹林片口服治疗,观察组采用阿司匹林联合阿托伐他汀钙片治疗。观察两组患者NIHSS评分,Barthel指数及血脂水平变化。结果两组患者治疗后NIHSS评分,Barthel指数与治疗前相比,差异均有统计学意义(P0.05),且观察组显著优于对照组(P0.05)。两组患者治疗后血脂水平均显著优于治疗前(P0.05),但观察组改善水平显著优于对照组,差异有统计学意义(P0.05)。两组治疗期间均未出现严重不良反应,观察组中出现胃肠道反应2例,对照组中出现胃肠道反患者1例,牙龈出血患者2例,均停药后自行恢复,两组患者不良反应发生率无明显统计学差异(P0.05)。结论他汀类药物联合阿司匹林治疗急性缺血性脑卒中的具有较好的临床效果,能有效改善患者脑神经功能,降低患者血脂水平及不良反应发生率,值得临床治疗中推广应用。     

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.     

盐酸美金刚治疗缺血性脑卒中研究进展

缺血性脑卒中是临床高发病,也是造成老年人永久残疾的重要原因之一。目前存在的治疗方法窗口期较短,寻找一种有效治疗缺血性脑卒中的药物是近年来研究的重点。盐酸美金刚是N-甲基-D-天冬氨酸受体拮抗剂,可有效缓解阿尔兹海默病的病程,近年来相关研究显示,盐酸美金刚可能具有治疗缺血性脑卒中的作用,综述该方面的研究进展,为相关药物的开发和治疗提供参考。     

硫酸镁对急性缺血性脑卒中的神经保护作用

目的探讨硫酸镁对急性缺血性脑卒中患者的神经保护作用。方法采用髓鞘碱性蛋白量化分析方法,分析急性缺血性脑卒中患者硫酸镁治疗前后血清髓鞘碱性蛋白水平变化的幅度,并与对照组对比。结果治疗组20例患者治疗前第1天血清髓鞘碱性蛋白平均水平为（8．3±2．5）μ∥L,治疗后第10天为（4．2±1．7）μg／L;对照组20例患者治疗前第1天血清髓鞘碱性蛋白平均水平为（8．0±3．0）μg／L,治疗后第10天为（6．0±1．4）μg／L。两组患者治疗前后血清髓鞘碱性蛋白水平变化幅度的差异具有统计学意义（t=1．231,P=0．041）。结论硫酸镁可显著降低急性缺血性脑卒中患者血清髓鞘碱性蛋白的水平,具有神经保护作用。     

介入治疗对老年急性冠状动脉综合征伴缺血性脑卒中患者的临床疗效

目的:探讨介入治疗(PCI)对老年急性冠状动脉综合征(ACS)伴缺血性脑卒中患者的临床疗效。方法:选取120例采用介入治疗的老年急性冠状动脉综合征患者为研究对象,根据诊断结果分为两组,每组60例。观察组患者伴缺血性脑卒中,对照组无脑卒中史。对两组患者病例、支架植入数量、血管造影检查结果及不良反应进行观察,并对患者预后的影响因素进行Logistic分析。结果:观察组糖尿病发病率、高血压发病率、肌酐水平、B型钠尿肽水平、肌钙蛋白Ⅰ水平、D-二聚体水平均显著高于对照组,差异有统计学意义(P<0.05);两组冠状动脉病变位置和支架置入数量比较,差异无统计学意义(P>0.05);两组不良反应比较,差异无统计学意义(P>0.05)。logistic回归分析结果显示:患者不良反应的危险因素为肌酐水平、ACS分型,与脑卒中史无关。结论:介入治疗老年急性冠状动脉综合征伴缺血性脑卒中疗效良好,且缺血性脑卒中史对住院期间不良反应的发生无影响。     

溶栓药物治疗缺血性卒中的进展

自16年前首次被证明静脉溶栓可有效治疗急性缺血性卒中以来,溶栓率一直不高。尽管很多试验证明了许多溶栓药物的疗效,但静脉注射用组织型纤溶酶原激活剂(rt-PA,0.9 mg.kg-1)几乎成为惟一用于溶栓治疗的溶栓剂。针对这种情况,研究者正在多方面对研究工作进行改进,包括使用新的溶栓药物。另外,研究者正在尝试用新的溶栓剂、低剂量的rt-PA、神经保护剂等减少症状性脑出血的危险。     

Drug-related problems in patients with ischemic stroke in hospital

Background Drug therapy is getting more complex, thus making it more challenging to prescribe appropriate drug therapy. Accordingly, in clinical practice, a wide range of drug-related problems (DRP) may arise; they are relatively common in hospitalised patients and can result in patient morbidity and mortality, and increased costs. Objective The objective was to investigate the nature and frequency of DRPs along with pharmaceutical interventions to address them in patients with ischemic stroke from hospital admission to discharge. Method From January to June 2011 patients with ischemic stroke, who were taking >2 drugs during hospital stay and at discharge, were recruited. A clinical pharmacist performed medication reconciliation on admission, and checked the medication records during the hospital stay regularly. DRPs were categorized by APS-Doc. Results In total, DRPs occurred in 105/155 (67.7?%) patients: Overall 271 DRPs were documented, with a mean of 1.8?±?2.0 DRPs per patient. The DRPs occurred mainly in the categories ??drug??, ??indication??, and ??dosage??. Conclusion In conclusion, DRPs are relatively common in hospitalised patients and may occur at any part of the prescribing process. The clinical pharmacist can provide a valuable contribution in the multidisciplinary team to an optimized pharmacotherapy in patients with ischemic stroke.     

Dl- 3 -n-Butylphthalide, a multi -target drug for the treatment of acute ischemic stroke

Stroke is the second leading cause of death following cancer in our country, the incidence of stroke is very high, followed by severe disability and mortality. So far, many drugs have been shown to be lack of efficacy in treatment of acute ischemic stroke.     

脑血管病治疗药物丁苯酞注射液的药理与临床研究评价

丁苯酞是我国原创的抗脑缺血新化学实体药物,属国家I类新药,具有保护线粒体和改善微循环的独特作用。丁苯酞软胶囊剂目前在临床用于急性缺血性脑卒中的治疗。丁苯酞注射液的开发弥补了丁苯酞软胶囊剂在治疗中尚存在的一些不足,如吞咽困难患者服药不便及口服生物利用度不理想。现对其药理作用、药动学、药物经济学以及对急性缺血性脑卒中的疗效和安全性进行综述。     

老年心房颤动患者应用阿司匹林与氯吡格雷抗血栓治疗的研究

目的探讨老年心房颤动（AF）患者应用阿司匹林与氯吡格雷抗血栓治疗的疗效及发生阿司匹林抵抗（AR）的预测因素。方法选择2006年6月至2008年6月在我院就诊老年AF患者168例,口服阿司匹林100mg/d,2周检测血栓素B2（TXB2）、尿11-脱氢-TXB2（11-DH-TXB2）、最大血小板聚集率（maximal platelet aggregation,PAgM）,根据PAgM从中筛选出AR患者41例。AR患者分别加服阿司匹林及氯吡格雷2周,测定血TXB2、尿11-DH-TXB2及PAgM。结果老年AF患者AR发生率为24.40%;非AR患者与AR患者比较,血TXB2、尿11-DH-TXB2显著下降（P〈0.01）;AR加服氯吡格雷患者PAgM显著降低（P〈0.01）,并无出血倾向（P〈0.05）。结论血TXB2、尿11-DH-TXB2及PAgM可能为AR的预测因素;AR患者加服氯吡格雷可能是一种有效的抗血栓治疗方法。     

羟乙基淀粉联合阿替普酶对缺血性脑卒中患者的疗效观察

目的探讨羟乙基淀粉联合阿替普酶对缺血性脑卒中患者的治疗作用。方法选择我院2010年4月至2014年6月收治的60例缺血性脑卒中患者作为研究对象,随机分为2组,对照组采用阿替普酶治疗,试验组在此基础上加用羟乙基淀粉治疗。比较两组患者的NIHSS评分、OPG、sTRAIL血清水平及疗效。结果治疗后,两组患者OPG和sTRAIL血清水平均有不同程度下降(P<0.05),两组治疗后OPG和sTRAIL血清水平比较差异有统计学意义(P<0.05);两组患者NIHSS评分均有不同程度下降(P<0.05),其中试验组在治疗后12 h、24 h及14 d时均低于对照组,差异有统计学意义(P<0.05)。试验组、对照组的总有效率分别为90.00%、73.33%,差异有统计学意义(P<0.05)。结论羟乙基淀粉联合阿替普酶治疗缺血性脑卒中可以显著下调血清OPG和sTRAIL水平,改善神经功能,临床治疗效果明显。     

Rodent models of ischemic stroke: a useful tool for stroke drug development

Stroke is the third common cause of death and the most common cause of adult disability. Approximately 80% of all strokes are ischemic (brain infarction). The only approved acute therapy is intravenous thrombolysis with tissue plasminogen activator within 3 h of symptom onset but only a small percentage of all ischemic stroke patients can receive this therapy. Therefore, novel therapeutic approaches directed at the pathophysiological mechanisms involved in ischemic brain injury are urgently needed. To this end several experimental stroke models were developed. These models are indispensable for understanding the pathophysiology of brain ischemia and to develop novel drugs and investigative methodology. This review considers the most commonly used ischemic stroke models (including preconditioning models) in rodents emphasizing their advantages and disadvantages. Since none of the models can perfectly simulate human stroke, researchers must interpret experimental findings carefully.