医学
抗血栓
脑出血
冲程(发动机)
心房颤动
不利影响
随机对照试验
内科学
危险系数
心脏病学
抗血小板药物
阿司匹林
氯吡格雷
置信区间
机械工程
蛛网膜下腔出血
工程类
作者
Rustam Al‐Shahi Salman,Steven M. Greenberg
出处
期刊:Stroke
[Ovid Technologies (Wolters Kluwer)]
日期:2023-11-02
卷期号:54 (12): 3173-3181
标识
DOI:10.1161/strokeaha.123.036886
摘要
This focused update about antiplatelet agents to reduce the high risk of major adverse cardiovascular events after stroke due to spontaneous (nontraumatic) intracerebral hemorrhage (ICH) complements earlier updates about blood pressure-lowering, lipid-lowering, and oral anticoagulation or left atrial appendage occlusion for atrial fibrillation after ICH. When used for secondary prevention in people without ICH, antiplatelet agents reduce the risk of major adverse cardiovascular event (rate ratio, 0.81 [95% CI, 0.75–0.87]) and might increase the risk of ICH (rate ratio, 1.67 [95% CI, 0.97–2.90]). Before 2019, guidance for clinical decisions about antiplatelet agent use after ICH has focused on estimating patients’ predicted absolute risks and severities of ischemic and hemorrhagic major adverse cardiovascular event and applying the known effects of these drugs in people without ICH to estimate whether individual ICH survivors in clinical practice might be helped or harmed by antiplatelet agents. In 2019, the main results of the RESTART (Restart or Stop Antithrombotics Randomized Trial) randomized controlled trial including 537 survivors of ICH associated with antithrombotic drug use showed, counterintuitively, that antiplatelet agents might not increase the risk of recurrent ICH compared to antiplatelet agent avoidance over 2 years of follow-up (12/268 [4%] versus 23/268 [9%]; adjusted hazard ratio, 0.51 [95% CI, 0.25–1.03]; P =0.060). Guidelines in the United States, Canada, China, and the United Kingdom and Ireland have classified the level of evidence as B and indicated that antiplatelet agents may be considered/reasonable after ICH associated with antithrombotic agent use. Three subsequent clinical trials have recruited another 174 participants with ICH, but they will not be sufficient to determine the effects of antiplatelet therapy on all major adverse cardiovascular events reliably when pooled with RESTART. Therefore, ASPIRING (Antiplatelet Secondary Prevention International Randomized Study After Intracerebral Hemorrhage) aims to recruit 4148 ICH survivors to determine the effects of antiplatelet agents after ICH definitively overall and in subgroups.
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