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We updated the 2002 Antiplatelet Trialists’ Collaboration meta‐analysis of antiplatelet therapy to assess the effects of aspirin alone in the secondary prevention of different types of thrombotic arterial disease. Results of randomized, placebo‐controlled trials of aspirin in patients with confirmed cardiovascular disease were abstracted and synthesized by the Mantel–Haenszel method. We defined three cardiovascular disease groups according to the qualifying disease at entry: coronary artery disease (CAD), cerebrovascular disease (CRVD), and peripheral arterial disease (PAD). Results are given as odds ratios (OR) and 95% confidence intervals (95% CI). Compared with placebo, aspirin decreased significantly the risk of all‐cause death in CAD and CRVD (OR = 0.80, 95% CI 0.75–0.86 and 0.91, 95% CI 0.85–0.98, respectively), and of vascular events in CAD, CRVD, and PAD (OR = 0.71, 95% CI 0.67–0.76, 0.87, 95% CI 0.82–0.93, and 0.50, 95% CI 0.29–0.88, respectively). The risk of non‐fatal stroke was decreased in the CAD, CRVD, and PAD (OR = 0.64, 95% CI 0.50–0.83, 0.81, 95% CI 0.74–0.89, and 0.26, 95% CI 0.07–0.94, respectively). The risk of non‐fatal myocardial infarction was decreased significantly in the CAD and CRVD (OR = 0.59, 95% CI 0.53–0.67, and 0.63, 95% CI 0.48–0.84, respectively), but not in the PAD (OR = 0.43, 95% CI 0.15–1.25). Aspirin nearly doubled the risk of major bleeds (OR = 1.87, 95% CI 1.51–2.32 for all clinical conditions). This meta‐analysis confirms that aspirin decreases the risk of thrombotic events in patients with confirmed disease of the coronary, cerebrovascular, or peripheral artery beds. 相似文献
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Rhynn J. MalloyAbir O. Kanaan PharmD Matthew A. SilvaJennifer L. Donovan PharmD 《Clinical therapeutics》2013
Background
The current guidelines recommend various antiplatelet agents used alone or in combination for secondary prevention of noncardioembolic stroke.Objective
The purpose of this study was to conduct a mixed treatment comparison meta-analysis to determine which antiplatelet or combination of antiplatelet agents is most efficacious and tolerable in patients with prior stroke.Methods
A comprehensive literature search was conducted in MEDLINE (1945 through March 2012), EMBASE (1974 through March 2012), and the Cochrane Controlled Trials Registry (1975 through April 2012) to identify randomized trials evaluating the role of various antiplatelet agents and combinations for the secondary prevention of stroke. Key articles were cross-referenced for additional studies. Data were screened and evaluated to generate direct and indirect comparisons for recurrent stroke and overall hemorrhagic events. Data were reported as rate ratios (RRs) and 95% CIs.Results
A total of 24 articles were included in the analysis. Eleven antiplatelet regimens were compared in >88,000 patients. The combination of acetylsalicylic acid (ASA) plus dipyridamole (DP) was more protective against recurrent stroke than ASA alone (RR = 0.78; 95% CI, 0.64–0.93), and no differences were found in all other direct and indirect comparisons with active treatment. ASA plus DP was associated with more overall hemorrhagic events than DP (RR = 1.83; 95% CI, 1.17–2.81), cilostazol (RR = 2.12; 95% CI, 1.21–3.48), and triflusal (RR = 1.67; 95% CI, 1.05–2.78) but fewer events than the combination of ASA plus clopidogrel (RR = 0.38; 95% CI, 0.25–0.56). The combination of ASA plus clopidogrel was associated with an excess of overall hemorrhagic events compared with clopidogrel (RR = 2.81; 95% CI, 1.96–4.10), cilostazol (RR = 5.56; 95% CI, 3.03–9.66), DP (RR = 4.78; 95% CI, 2.80–8.21), sarpogrelate (RR = 3.59; 95% CI, 1.96–6.45), terutroban (RR = 2.13; 95% CI, 1.21–3.61), ticlopidine (RR = 2.80; 95% CI, 1.69–5.00), and triflusal (RR = 4.36; 95% CI, 2.62–7.81).Conclusion
We found that ASA plus DP was more protective than ASA alone for preventing recurrent stroke; however, no difference was found between most direct and indirect comparisons of antiplatelet agents and combinations. More overall hemorrhagic events seemed to occur with the combination of ASA and clopidogrel than with other treatments. Selection of antiplatelet therapy for the secondary prevention of stroke must be individualized according to patient comorbidities, including risk of stroke recurrence and bleeding. 相似文献5.
《Ultrasound in medicine & biology》2020,46(9):2173-2180
Our objective was to evaluate hand-held echocardiography as point of care ultrasound scanning (POCUS) to detect sources of embolism in the acute phase of stroke. Prospective, unicentric observational cohort study of non-lacunar ischemic stroke patients evaluated by V Scan device. The main sources of embolism (MSEs) were classified into embolic valvulopathies and severe ventricular dysfunction. We looked for atrial fibrillation (AF) predictors in strokes of undetermined etiology. MSEs were detected in 19.23% (25/130). Large vessel occlusion (LVO) (odds ratio [OR]: 4.24, 95% confidence interval [CI]: 1.01–17.85) and chronic heart failure (OR: 13.25, 95% CI: 3.54–49.50) were independent predictors of MSEs. LVO (OR: 6.54, 95% CI: 1.62–26.27) and left atrial area >20 cm2 (OR: 7.01, 95% CI: 1.75–28.09) independently predicted AF. Patients with LVO and chronic heart disease may benefit from hand-held echocardiography as part of POCUS in the acute phase of ischemic stroke. Left atrial area measured was an independent predictor of AF in strokes of undetermined etiology. 相似文献
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Self-reported urinary incontinence in noninstitutionalized long-term stroke survivors: A population-based study 总被引:1,自引:0,他引:1
Jørgensen L Engstad T Jacobsen BK 《Archives of physical medicine and rehabilitation》2005,86(3):416-420
OBJECTIVES: To compare the prevalence of self-reported incontinence among noninstitutionalized long-term stroke survivors with population controls without stroke and to identify risk factors associated with urinary incontinence in the stroke survivors. DESIGN: Community-based, cross-sectional study. SETTING: Municipality of Tronso. PARTICIPANTS: A total of 213 noninstitutionalized stroke survivors (mean time poststroke, 9y) and 242 control subjects. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Self-reported presence of urinary incontinence. RESULTS: Urinary incontinence was present in 17% of the stroke survivors and in 7% of the control subjects (odds ratio [OR]=2.8; 95% confidence interval [CI], 1.5-5.2) and more prevalent among the stroke survivors than among the control subjects until 10 years poststroke. In the stroke survivors, urinary incontinence was associated with signs of depression (OR=3.0; 95% CI, 1.3-7.1) and tended to be associated with motor function of the leg (OR=3.1; 95% CI, 0.9-10.4) and cognitive function (OR=2.8; 95% CI, 0.9-8.6). Urinary incontinence was strongly related to the number of these risk factors present ( P trend, <.001; OR=7.2; 95% CI, 2.1-24.6) in subjects having 2 or more of the risk factors, compared with subjects with none of these risk factors). CONCLUSIONS: The prevalence of urinary incontinence is high among long-term stroke survivors, especially in subjects in whom paresis, depressive symptoms, and impaired cognition cluster. 相似文献
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We studied the prevalence of chronic pain and long term sensory changes after cosmetic augmentation mammoplasty and the effects of a single i.v. preoperative dose of methylprednisolone 125 mg (n=74), parecoxib 40 mg (n=71), or placebo (n=74). A questionnaire was mailed 6 weeks and 1 year after surgery. Response rate after 1 year was 80%. At 1 year non-evoked pain was present in 13%, and evoked pain was present in 20% with no statistically significant differences between the groups. Methylprednisolone was associated with reduced odds for hyperesthesia at 1 year (OR 0.3, 95% CI 0.1-0.6), and significantly reduced the prevalence of hyperesthesia (30%) compared with placebo (56%, P<0.01) and parecoxib (51%, P<0.04). Factors associated with increased odds for pain at 1 year were intensity of pain during the first 6 days after surgery (OR 1.3, 95% CI 1.1-1.6), pain at 6 weeks (OR 18.4, 95% CI 6.9-49.3), hyperesthesia at 6 weeks (OR 2.3, 95% CI 1.1-5.1) and present hyperesthesia (OR 3.1, 95% CI 1.4-6.7). We conclude that persistent pain and sensory changes are common after augmentation mammoplasty, and that patients having pain at 6 weeks most likely will have pain also at 1 year. Acute postoperative pain, hyperesthesia at 6 weeks, and the presence of hyperesthesia increased the odds for pain at 1 year. Preoperative methylprednisolone resulted in significantly less hyperesthesia compared with both parecoxib and placebo, but did not significantly reduce the prevalence of persistent spontaneous or evoked pain. 相似文献
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Schwedt TJ Hentz JG Dodick DW 《Cephalalgia : an international journal of headache》2007,27(6):528-534
We set out to identify predictors for the prophylactic effect of placebo injections in subjects with migraine by post hoc analysis of 81 subjects with episodic migraine receiving single-blind placebo injections in a prospective trial of botulinum toxin. Possible predictors of placebo prophylaxis were compared among placebo responders (PRs) and placebo non-responders (PNRs). There were 34 PRs (42%) and 47 PNRs (58%). Male gender [odds ratio (OR) 5.83, 95% confidence interval (CI) 1.12, 30.14, P = 0.022], a history of opioid use (OR 4.44, 95% CI 1.47, 13.41, P = 0.005) and injections in the neck/shoulders (OR 2.44, 95% CI 0.93, 3.19, P = 0.033) were associated with placebo response. Of subjects with two or more of these signs, 88% were PRs compared with 31% of subjects with one or less. Male gender, opioid use and injections in the neck/shoulders are associated with placebo prophylaxis. These findings may have important implications for the design of future clinical trials and for the clinical management of migraineurs. 相似文献
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Dumont L Lysakowski C Tramèr MR Junod JD Mardirosoff C Tassonyi E Kayser B 《Clinical science (London, England : 1979)》2004,106(3):269-277
Magnesium is a physiological N-methyl-D-aspartate (NMDA) antagonist. The NMDA receptor may be involved in the pathogenesis of acute mountain sickness (AMS). In the present study, healthy subjects were randomized to receive either 400 mg of oral magnesium citrate (16 mmol) or matching placebo every 8 h for 5 days (prevention trial). Subjects then climbed to 4559 m in approx. 24 h and stayed there for 48 h. A Lake Louise Score <3 at any time was defined as the absence of AMS, whereas a score >6 (with ataxia, headache and nausea) was defined as a prevention failure. In a subsequent trial (treatment trial), subjects with a Lake Louise Score >6 (with ataxia, headache and/or nausea) were randomized to receive either 4 g of intravenous magnesium sulphate (16 mmol) or matching placebo. A decrease in the score >50% within 60 min was regarded as a treatment success. Dichotomous data were analysed using relative risk (RR) or odds ratio (OR), and continuous data using Student's t test or Wilcoxon's rank-sum test. In the prevention trial, data from 61 subjects (30 receiving magnesium and 31 placebo) were analysed. With oral magnesium, 20% of subjects had no AMS compared with 16.1% in the placebo group [RR (95% CI), 1.2 (0.4-3.6); where CI is confidence interval]. With magnesium, 40% were prevention failures compared with 35.5% in the placebo group [RR (95% CI), 1.13 (0.59-2.15)]. The mean time to failure and severity of AMS was similar between the two groups. With magnesium, 38.2% had loose stools compared with 11.8% in placebo group [RR (95% CI), 3.25 (1.18-8.97)]. In the treatment trial, 12 subjects received magnesium and 13 received the placebo. With intravenous magnesium, 25% were regarded as treatment successes compared with none in the placebo group [OR (95% CI), 9.71 (0.91-103.4)]. With magnesium, mean (+/- S.D.) scores decreased from 11.6 +/- 1.7 before treatment to 9.0 +/- 3.5 after treatment (P=0.009); scores remained unchanged in the placebo group. With magnesium, 75% of subjects experienced a transient flushing compared with 7.7% in the placebo group [RR (95% CI), 0.05 (0.01-0.25)]. In conclusion, oral magnesium does not prevent AMS. In subjects with established AMS, intravenous magnesium reduces the severity of symptoms to some extent, but this effect is of no clinical importance. 相似文献
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F. DENTALI W. AGENO E. REZOAGLI E. RANCAN A. SQUIZZATO S. MIDDELDORP M. MARGAGLIONE E. GRANDONE 《Journal of thrombosis and haemostasis》2012,10(10):2075-2085
Summary. Background: It was hypothesized that low‐dose aspirin could improve implantation rates in subsequent pregnancies in women undergoing in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI). Previous studies have shown inconclusive results or focused on surrogate endpoints. We therefore conducted a systematic review and meta‐analysis of the literature investigating the effect of low‐dose aspirin on hard outcomes, including live birth rate, pregnancy rate and miscarriage. Methods: MEDLINE and EMBASE databases were searched up to November 2011. Randomized controlled trials comparing low‐dose aspirin with placebo/no treatment in IVF/ICSI women were included. Pooled odds ratios (ORs) and 95%confidence intervals (CIs) were calculated. Results: Seventeen studies with 6403 patients were included. The use of aspirin did not improve live birth pregnancy rate compared with placebo or no treatment (1.08; 95% CI, 0.90, 1.29). Pregnancy rates were significantly increased in patients randomized to low‐dose aspirin (OR, 1.19; 95% CI, 1.01, 1.39), but miscarriage rates were not (OR, 1.18; 95% CI, 0.82, 1.68). Results of sensitivity analyses including high‐quality studies did not show statistically significant differences in all considered endpoints. Conclusions: The results of this study do not show a substantial efficacy of aspirin inwomen undergoing IVF/ICSI and do not support the use of low‐dose aspirin to improve the success of IVF/ICSI in terms of pregnancy outcomes. Further high‐quality studies evaluating the possible efficacy of aspirin in selected groups of patients are warranted. 相似文献
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《Journal of Vascular Nursing》2021,39(4):91-99
ObjectiveIt is well known that post-stroke depression might be a negative factor for stroke recovery, however there is limited evidence to establish the link between pre-stroke depression and stroke outcome such motor recovery. The objective is to determine clinical risk factors in ischemic stroke patients with pre-stroke depression that are associated functional ambulatory outcome.MethodsData from acute ischemic patients from a regional stroke registry were collected for consecutive recombinant tissue plasminogen activator(rtPA)-treated acute ischemic stroke patients between January 2010 and June 2016. Logistic regression model was used to predict risk factors that served as predictive variables, while the increase or reduce odds of improvement in ambulatory outcome was considered as the primary outcome. Multicollinearity and possible interactions among the independent variables were analyzed using the variance inflation factor.ResultsA total of 1446 patients were eligible for recombinant tissue plasminogen activator (rtPA) and 596 of these patients received rtPA. Of the 596 ischemic stroke patients, 286 patients presented with recent pre-stroke depression, 310 had no pre-stroke depression. Carotid artery stenosis (OR = 11.577, 95% CI, 1.281–104.636, P = 0.029) and peripheral vascular disease (OR = 18.040, 95% CI, 2.956–110.086, P = 0.002) were more likely to be associated with increase odds of improvement in ambulation in patients with no pre-stroke depression treated with rtPA, while antihypertensive medications (OR = 0.192, 95% CI, 0.035–1.067, P = 0.050),previous TIA (OR = 0.177, 95% CI, 0.038–0.818, P = 0.027), and congestive heart failure (OR = 0. 0.160, 95% CI, 0.030–0.846, P = 0.031) were associated with reduced odds of improvement in ambulation. In addition, carotid artery stenosis (OR = 0.078, 95% CI, 0.10-0.614, P = 0.015, congestive heart failure (OR = 0.217, 95% CI, 0.318–0.402, P = 0.030), previous TIA (OR = 0.444, 95% CI, 0.517–0.971, P = 0.012), higher NIHSS scores ((OR = 0.887, 95% CI, 0.830–0.948, P < 0.001), and antihypertensive medications (OR = 0.810, 95% CI, 0.401–0.529, P = 0.019) were associated with the reduced odd of improvement in ambulation in an ischemic stroke population with pre-stroke depression treated with rtPA.ConclusionOur findings indicate that more risk factors were associated with the decreased odds of an improvement in ambulation following thrombolytic therapy in an ischemic stroke population with pre-stroke depression when compared with those without pre-stroke depression. This finding maybe helpful in the development of management strategies to increase the use of thrombolytic therapy for pre-stroke depressed ischemic stroke to increased their eligibility for rtPA. 相似文献
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《Expert review of cardiovascular therapy》2013,11(7):749-753
Evaluation of: The ACTIVE Investigators. Effect of clopidogrel added to aspirin in patients with atrial fibrillation. N. Engl. J. Med. 360(20), 2066–2078 (2009).Atrial fibrillation (AF) is the most common heart rhythm disorder and increases the risk for stroke by fivefold. Therefore, antithrombotic pharmacological agents are recommended and commonly used to prevent stroke and thromboembolic vascular events in patients with AF. Although, aspirin is an effective and acceptable agent for low-risk patients, oral vitamin K antagonists anticoagulants have superiority over aspirin in patients with AF who are at high risk for complications. However, given several practical impediments, vitamin K antagonists may not be suitable for certain high-risk patients with AF. It is not unusual for clinicians to encounter situations where selection of appropriate pharmacotherapy options for stroke prevention may be quite challenging in high-risk patients with AF who are deemed to be unsuitable candidates for oral anticoagulants. It may be hypothesized that, in such a situation, a combination of clopidogrel with aspirin, possibly by their additive effect in the prevention of platelet-mediated thrombosis may be used effectively instead of oral anticoagulants. In this article, we have discussed this issue and review one of the recently published Atrial Fibrillation Clopidogrel Trial with Irbesartan for Prevention of Vascular Events (ACTIVE) studies, the ACTIVE-A trial, in which the treatment strategies utilizing ‘clopidogrel plus aspirin’ and ‘aspirin alone’ in patients with AF who were at increased risk for stroke and for whom therapy with a vitamin K antagonist was considered unsuitable were compared. 相似文献
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Matchaba P Gitton X Krammer G Ehrsam E Sloan VS Olson M Mellein B Hoexter G Orloff J Garaud JJ 《Clinical therapeutics》2005,27(8):1196-1214
BACKGROUND: The cardiovascular (CV) safety of non-steroidal anti-inflammatory drugs (NSAIDs) and selective cyclooxygenase-2 inhibitors has been the subject of considerable debate. OBJECTIVE: The objective of this study was to determine the risk of CV events with lumiracoxib by meta-analysis of all completed, randomized controlled trials (RCTs) of > or =1 week and up to 1 year in duration of patients with osteoarthritis and rheumatoid arthritis. METHODS: The Novartis Lumiracoxib Clinical Trial Database, which includes all clinical studies conducted to date with lumiracoxib, was reviewed. Data were extracted from RCTs of > or =1 week and up to 1 year in duration, the maximum study duration; 34,668 patients were included in standard and cumulative meta-analyses. Twenty-two RCTs of lumiracoxib 100 to 1200 mg daily were identified; 22,781 patients were included in 1-year trials. Mean age of the patients was 61.5 years and 74% were female. More than 50% of the patients in these studies had hypertension at baseline and 6% had diabetes. Parameters analyzed were the Antiplatelet Trialists' Collaboration (APTC) composite CV end point of myocardial infarction (MI), stroke (ischemic and hemorrhagic), and CV death; MI alone; and stroke alone. Twenty-one of the 22 RCTs have been published. RESULTS: For all 3 parameters, relative risk (RR) was calculated versus non-naproxen NSAIDs, naproxen, and placebo. The results were as follows: for the APTC end point versus non-naproxen NSAIDs: RR 0.83, 95% CI, 0.46-1.51; versus naproxen: RR 1.49, 95% CI, 0.94-2.36; versus placebo: RR 1.08, 95% CI, 0.41-2.86; for MI alone versus non-naproxen NSAIDs: RR 0.80, 95% CI, 0.28-2.25; versus naproxen: RR 1.69, 95% CI, 0.82-3.48; versus placebo: RR 1.27, 95% CI, 0.25-6.56; and for stroke alone versus non-naproxen NSAIDs: RR 0.91, 95% CI, 0.35-2.35; versus naproxen: RR 1.42, 95% CI, 0.70-2.91; versus placebo: RR 0.59, 95% CI, 0.13-2.74. Cumulative meta-analyses of lumiracoxib versus all comparators (placebo, diclofenac, ibuprofen, celecoxib, rofecoxib, and naproxen) did not find any significant differences in APTC, MI alone, or stroke alone. CONCLUSION: This meta-analysis of 34,668 patients receiving > or =1 week and up to 1 year of treatment found no evidence that lumiracoxib was associated with a significant increase in CV risk compared with naproxen, placebo, or all comparators (placebo, diclofenac, ibuprofen, celecoxib, rofecoxib, and naproxen). 相似文献
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BackgroundWe aimed to evaluate the risk of major bleeding in non-surgical critically ill patients who received aspirin in conjunction with therapeutic anticoagulation (concomitant therapy) compared to those who received therapeutic anticoagulation alone.MethodsThis is a retrospective cohort study of critically ill patients initiated on therapeutic anticoagulation at a large academic medical center from 2007 to 2016. The exposure of interest was aspirin therapy during anticoagulation. The primary outcome was the incidence of major bleeding during hospitalization. Secondary outcomes included in-hospital mortality, hospital free days, and new myocardial infarction or stroke.Results5507 (73.2%) patients received anticoagulation alone and 2014 (26.8%) received concomitant therapy; major bleeding occurred in 19.0% and 22.2%, respectively. There was no increased risk of major bleeding [OR 1.10 (95% CI: 0.93–1.30); p = .27] or mortality [OR 0.93 (95% CI: 0.77–1.11); p = .43] with concomitant therapy. Patients receiving concomitant therapy had fewer hospital-free days (mean decrease of 0.73 [1.36, 0.09]; p = .03) and were more likely to experience new myocardial infarction or stroke [OR 2.61 (95% CI: 1.72–3.98); p < .001].ConclusionsIn non-surgical critically ill patients receiving therapeutic anticoagulation, concomitant use of aspirin was not associated with an increased risk of bleeding or in-hospital mortality. 相似文献
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Nai-Chuan Chen Ming-Ju Hsieh Sung-Chun Tang Wen-Chu Chiang Kuang-Yu Huang Li-Kai Tsai Patrick Chow-In Ko Matthew Huei-Ming Ma Jiann-Shing Jeng 《The American journal of emergency medicine》2013
Purposes
The aim of this study was to investigate the factors associated with use of emergency medical services (EMS) in patients with acute stroke.Methods
Prospective data on consecutive patients with acute stroke who presented to the emergency department of a university medical center from January 1, 2010, to July 31, 2011, were analyzed. Patients were excluded if they had an unknown residence, had onset of stroke at a nursing home or hospital, or were transferred from another hospital. Variables for all patients with stroke and ischemic stroke who did and did not use EMS were compared.Results
In total, 1344 patients (60% male; mean age, 68.7 years) were included. Use of EMS (n = 409; 30.4%) was significantly associated with a higher level of education (≧ 6 years vs < 6 years; odds ratio [OR], 1.69; 95% confidence interval [CI], 1.25-2.29), a higher National Institutes of Health Stroke Scale score (OR, 1.08; 95% CI, 1.05-1.11), altered consciousness (OR, 1.88; 95% CI, 1.25-2.84), and atrial fibrillation (OR, 2.43; 95% CI, 1.71-3.44) after adjustment. For patients with ischemic stroke, use of EMS was significantly higher in cases of cardioembolism (OR, 3.04; 95% CI, 1.40-6.60) and large artery atherothrombosis (OR, 2.10; 95% CI, 1.22-3.62) than lacunar infarction.Conclusion
Patients with stroke who have altered consciousness, a higher level of education, a higher National Institutes of Health Stroke Scale score, atrial fibrillation, and cardioembolic stroke were more likely to use EMS. 相似文献17.
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Potpara TS Polovina MM Licina MM Stojanovic RM Prostran MS Lip GY 《Advances in therapy》2012,29(6):491-507
Stroke prevention in atrial fibrillation (AF) has been challenging over decades, mostly due to a number of difficulties associated with oral vitamin K antagonists (VKAs), which have been the most effective stroke prevention treatment for a long time. The oral direct thrombin inhibitors (e.g., dabigatran) and oral direct inhibitors of factor Xa (e.g., rivaroxaban, apixaban) have emerged recently as an alternative to VKAs for stroke prevention in AF. These drugs act rapidly, and have a predictable and stable dose-related anticoagulant effect with a few clinically relevant drug-drug interactions. The novel oral anticoagulants are used in fixed doses with no need for regular laboratory monitoring of anticoagulation intensity. However, each of these drugs has distinct pharmacological properties that could influence optimal use in clinical practice. The following phase 3 randomized trials with novel oral anticoagulants versus warfarin for stroke prevention in AF have been completed: the Randomized Evaluation of Long-term Anticoagulant therapy (RE-LY) trial with dabigatran, the Rivaroxaban Once daily oral direct Factor Xa inhibition Compared with vitamin K antagonism for prevention of stroke and Embolism Trial in Atrial Fibrillation (ROCKET-AF) trial with rivaroxaban, and the Apixaban for Reduction of Stroke and Other Thromboembolism Events in Atrial Fibrillation (ARISTOTLE) trial with apixaban. Moreover, the Apixaban Versus Acetylsalicylic Acid to prevent Strokes (AVERROES) trial included patients with AF who have failed or were unsuitable for warfarin, and compared apixaban versus aspirin for stroke prevention in AF. Overall, apixaban has two large trials for stroke prevention in AF showing benefits not only over warfarin, but also over aspirin among those patients who have failed or refused warfarin. In the ARISTOTLE trial, apixaban was superior to warfarin in the reduction of stroke or systemic embolism, major bleeding, intracranial hemorrhage, and all-cause mortality, with a similar reduction in the rate of ischemic stroke and better tolerability. When compared with aspirin in the AVERROES trial, apixaban was associated with more effective reduction of stroke, a similar risk of major bleeding, and better tolerability. In this review article, the authors summarize the current knowledge on novel oral anticoagulants and discuss the clinical aspects of their use for stroke prevention in AF, with particular emphasis on apixaban. 相似文献
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Hyung Ju Kim Jung Hwan Ahn Sun Hyu Kim Eun Seog Hong 《The Journal of emergency medicine》2011,41(1):59-63
Background: Early hospital presentation is critical in the treatment of acute ischemic stroke with thrombolysis. Objectives: The aim of this study was to investigate the factors associated with prehospital delay in acute ischemic stroke. Methods: Data were retrospectively collected over a 1-year period from 247 acute ischemic stroke patients who presented to the emergency department (ED) within 7 days after symptom onset. To investigate the factors associated with prehospital delay, sociodemographic data, initial symptoms, risk factor, National Institutes of Stroke Scale in the ED, and use of emergency medical services (EMS) were evaluated. Univariate and multivariate analysis were used to evaluate delay factors. Results: Of 247 patients (mean age 64.4 ± 12.6 years, 149 male patients), the non-delay group (≤ 2 h after symptom onset) included 45 patients (mean age 60.0 ± 13.1 years, 31 male patients) and the delay group (> 2 h after symptom onset) included 202 patients (mean age 65.4 ± 12.3 years, 118 male patients). Advanced age (odds ratio [OR] 1.056, 95% confidence interval [CI] 1.024-1.089), no consciousness disturbance at symptom onset (OR 2.938, 95% CI 1.066-8.104), presentation to ED by self (OR 3.826, 95% CI 1.580-9.624), referral from other hospital (OR 16.787, 95% CI 5.445-51.750), and worsened symptoms at the ED compared to symptom onset (OR 7.708, 95% CI 1.557-38.151) were associated with a prehospital delay. Conclusion: Elderly patients with progressive symptom worsening had delayed arrival, but those who used EMS or had disturbed consciousness at symptom onset had early arrival. 相似文献
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M. RIGHINI G. LE GAL D. AUJESKY P.‐M. ROY O. SANCHEZ F. VERSCHUREN O. T. RUTSCHMANN T. PERNEGER A. PERRIER 《Journal of thrombosis and haemostasis》2012,10(3):347-351
Summary. Background: A pulmonary embolism (PE) is thought to be associated with atrial fibrillation (AF). Nevertheless, this association is based on weak data. Objectives: To assess whether the presence of AF influences the clinical probability of PE in a cohort of patients with suspected PE and to confirm the association between PE and AF. Patients/methods: We retrospectively analyzed the data from two trials that included 2449 consecutive patients admitted for a clinically suspected PE. An electrocardiography (ECG) was systematically performed and a PE was diagnosed by computer tomography (CT). The prevalence of AF among patients with or without a PE was compared in a multivariate logistic regression model. Results: The prevalence of PE was 22.8% (519/2272) in patients without AF and 18.8% (25/133) in patients with AF (P = 0.28). After adjustment for confounding factors, AF did not significantly modify the probability of PE (odds ratio [OR] 0.68, 95% confidence interval [CI] 0.42–1.11). However, when PE suspicion was based on new‐onset dyspnea, AF significantly decreased the probability of PE (OR 0.47, 95% CI 0.26–0.84). If isolated chest pain without dyspnea was the presenting complaint, AF tended to increase the probability of PE (OR 2.42, 95% CI 0.97–6.07). Conclusions: Overall, the presence of AF does not increase the probability of PE when this diagnosis is suspected. Nevertheless, when PE suspicion is based on new‐onset dyspnea, AF significantly decreases the probability of PE, as AF may mimic its clinical presentation. However, in patients with chest pain alone, AF tends to increase PE probability. 相似文献