Three even Lancet stroke, new research results of you think! 2019 | ESOC

22-24 May 2019, the fifth European Stroke Conference, European Stroke levels are Conference, ESOC) was held in milan, Italy.

as stroke research one of the most important meeting in Europe, ESOC 2019 issued 23 important clinical research results, has attracted more than 4500 experts and scholars participate in. Meeting with three studies particularly striking, not only cause people at the meeting, published in the Lancet and the ZiKan more. Next, let us grasp the main points, walk in the forefront of stroke!

1 for: cerebral hemorrhage after restart antiplatelet, reduce the risk of recurrence of nearly half

although it is widely concerned in the intracranial hemorrhage, intracranial hemorrhage, for example) related to start taking aspirin or clopidogrel again after stroke and other antiplatelet drugs may increase the risk of recurrence of cerebral hemorrhage, but recent research has found that the result is just the opposite - ICH restart antiplatelet therapy and after 2 years, for example about a 49% lower risk of recurrence.

this prospectie, randomized open label RESTART study in May 2013-2018, May 122 hospitals from Britain recruited 537 participants. 525 by the brain CT/MRI diagnosis of hemorrhagic stroke, 97% after brain CT diagnosis, 48% after brain MRI diagnosis. 268 patients taking antiplatelet therapy, and the other 269 patients were not treated with aspirin or clopidogrel, the researchers for its symptomatic cerebral hemorrhage recurrence and the occurrence of ischemic stroke practice for 5 years of follow-up.

it was found that antiplatelet therapy group of the communist party of 12 cases of recurrence of cerebral hemorrhage (4.5%), bleeding and recurrence in group did not receive antiplatelet therapy has achieved the 23 cases (8.6%), and expected results are very different to restart antiplatelet therapy was likely instead, reduce the risk of nearly half of recurrent cerebral hemorrhage (aHR 0.51, 95% CI 0.25 to 1.03; P=0.060).

the study also pointed out that for the brain there is/there is no micro hemorrhage (aHR 0.30, 95% CI 0.08 to 1.13 vs. 0.77, 0.13-4.61; P for interaction=0.41), the hemorrhage quantity at 0 and 1, 2-4 or 5 in the above (0.77, 0.13 4.62 vs. 0.32, 0.03 to 3.66 vs. 0.33, 0.07-1.60; P=0.75), interaction/other position exactly a brain hemorrhage (0.52, 0.004 6.79 vs. 0.37, 0.09-1.28; P=0.85) in patients with interaction between the use of antiplatelet therapy and recurrent cerebral hemorrhage in clinical or were not found significant statistically significant and subgroup analysis found no other influential factors for antiplatelet therapy results.

on ESOC 2019, the study's lead author, from the UK, a professor at the university of Edinburgh, Scotland, Salman RA - S said that the results of a study he breathed a sigh of relief. Because he has been very worried about restart cerebral hemorrhage patients antiplatelet therapy may lead to increased risk of relapse. As the first explore the antiplatelet therapy for prospective study the prognosis of patients with cerebral hemorrhage medical history, study the similar results with previous observational studies and further proved the security of treatment.

compared to previously published aspirin for cardiovascular primary prevention invalid as a result, the study focuses on the has had a history of cardiovascular patients, this means that these patients with cerebrovascular may have a problem. For this group, aspirin seems to be an appropriate choice. However, the researchers admit that the current study sample size is limited, not enough to have further antiplatelet therapy for which patients better. A commentary article, and at the same time from the university of Copenhagen Christensen H, points out that we should focus on patients in the treatment itself, rather than the imaging results, and that this research will promote the change of clinical practice.

  参考文献:

  [1] Salman RA-S, Minks DP, Mitra D, et al. Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial. Lancet Neurol, May 22, 2019. doi: 10.1016/S1474-4422(19)30184-X.

  [2] Christensen H. Antiplatelets after intracerebral haemorrhage: treat the patient, not the brain imaging. Lancet Neurol, May 22, 2019. doi: 10.1016/S1474-4422(19)30189-9.

  [3] Damian McNamara. Restarting Antiplatelet After ICH Cuts Recurrence Risk in Half. Medscape. May 23, 2019. 5th European Stroke Organisation Conference (ESOC) 2019: Presented May 22, 2019. Accessed at https://www.medscape.com/viewarticle/913431on 2019-05-24.

  2 权衡得失:微出血患者或仍应抗栓预防缺血性卒中