Antithrombotic Therapy to Prevent Recurrent Strokes in Ischemic Cerebrovascular Disease JACC Scientific Expert Panel
Antithrombotic Therapy to Prevent Recurrent Strokes in Ischemic Cerebrovascular Disease JACC Scientific Expert Panel
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DOI：
10.1016/j.jacc.2019.06.039
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发表时间：
2019-08-13
影响因子：
24
通讯作者：
Sacco, Ralph L.
中科院分区：
文献类型：
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作者：
Del Brutto, Victor J.;Chaturvedi, Seemant;Sacco, Ralph L.
中风幸存者有很高的复发风险。抗血栓药物对于二级预防至关重要，因此对于降低总体卒中负担至关重要。适当的抗血栓药物的选择应基于对导致初始缺血性损伤的生理病理学机制的最佳理解。抗血小板治疗对于以动脉粥样硬化和内皮损伤为特征的病变是优选的，而抗凝剂对于心源性栓塞和高度血栓性疾病是有利的。大型随机对照试验提供了新的数据，支持卒中后使用抗血小板药物和抗凝剂的循证建议。在这篇综述中，作者涵盖了最近改变临床实践的试验，引用了系统性综述和荟萃分析，回顾了基于旧的里程碑式试验的循证建议，并指出了仍存在证据差距和正在进行的新试验。(C)2019年由美国心脏病学会基金会。
Stroke survivors carry a high risk of recurrence. Antithrombotic medications are paramount for secondary prevention and thus crucial to reduce the overall stroke burden. Appropriate antithrombotic agent selection should be based on the best understanding of the physiopathological mechanism that led to the initial ischemic injury. Antiplatelet therapy is preferred for lesions characterized by atherosclerosis and endothelial injury, whereas anticoagulant agents are favored for cardiogenic embolism and highly thrombophilic conditions. Large randomized controlled trials have provided new data to support recommendations for the evidence-based use of antiplatelet agents and anticoagulant agents after stroke. In this review, the authors cover recent trials that have altered clinical practice, cite systematic reviews and meta-analyses, review evidence-based recommendations based on older landmark trials, and indicate where there are still evidence-gaps and new trials being conducted. (C) 2019 by the American College of Cardiology Foundation.