THE WARFARIN-ASPIRIN SYMPTOMATIC INTRACRANIAL DISEASE STUDY
THE WARFARIN-ASPIRIN SYMPTOMATIC INTRACRANIAL DISEASE STUDY
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DOI：
10.1212/wnl.45.8.1488
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发表时间：
1995-08-01
期刊：
影响因子：
9.9
通讯作者：
FAYAD, PB
中科院分区：
文献类型：
--
作者：
CHIMOWITZ, MI;KOKKINOS, J;FAYAD, PB
我们进行了一项回顾性、多中心研究，比较华法林与阿司匹林在预防颅内主要动脉症状性狭窄患者发生主要血管事件（缺血性卒中、心肌梗死或猝死）方面的疗效。通过审查1985年至1991年期间在参与中心进行的连续血管造影结果，确定颅内动脉（颈动脉;大脑前、中或后动脉;椎动脉;或基底动脉）狭窄50 - 99%的患者。只有狭窄动脉区域内的TIA或卒中患者才有资格入选本研究。根据当地医生的偏好，为患者开具华法林或阿司匹林，并进行病历审查和个人或电话访谈。7个中心入组了151例患者; 88例接受华法林治疗，63例接受阿司匹林治疗。中位随访时间为14.7个月（华法林组）和19.3个月（阿司匹林组）。两组的血管危险因素和有症状动脉的平均狭窄百分比相似，但阿司匹林组的主要血管事件发生率为18.1/100患者年（卒中率，10.4/100患者-年;心肌梗死或猝死率，7.7/100患者-年），而华法林组的随访率为8.4/100患者-年（卒中率，3.6/100患者-年;心肌梗死或猝死率，4.8/100患者-年）。Kaplan-Meier分析显示，接受华法林治疗的患者中无重大血管事件的患者百分比显著较高（p = 0.01）。与阿司匹林治疗的患者相比，华法林治疗的患者发生主要血管事件的相对风险为0.46（95%CI，0.23 - 0.86）。在166患者年的随访中，3例华法林患者（包括2例死亡）发生了严重出血并发症，在143患者年的随访中，没有一例阿司匹林患者发生了严重出血并发症。本研究表明，在预防症状性颅内大动脉狭窄患者的主要血管事件方面，华法林与阿司匹林相比具有有利的风险/获益比。需要一项前瞻性随机研究来证实这些发现。
We conducted a retrospective, multicenter study to compare the efficacy of warfarin with aspirin for the prevention of major vascular events (ischemic stroke, myocardial infarction, or sudden death) in patients with symptomatic stenosis of a major intracranial artery. Patients with 50 to 99% stenosis of an intracranial artery (carotid; anterior, middle, or posterior cerebral; vertebral; or basilar) were identified by reviewing the results of consecutive angiograms performed at participating centers between 1985 and 1991. Only patients with TIA or stroke in the territory of the stenotic artery qualified for inclusion in the study. Patients were prescribed warfarin or aspirin according to local physician preference and were followed by chart review and personal or telephone interview. Seven centers enrolled 151 patients; 88 were treated with warfarin and 63 were treated with aspirin. Median follow-up was 14.7 months (warfarin group) and 19.3 months (aspirin group). Vascular risk factors and mean percent stenosis of the symptomatic artery were similar in the two groups, yet the rates of major vascular events were 18.1 per 100 patient-years of follow-up in the aspirin group (stroke rate, 10.4/100 patient-years; myocardial infarction or sudden death rate, 7.7/100 patient-years) compared with 8.4 per 100 patient-years of follow-up in the warfarin group (stroke rate, 3.6/100 patient-years; myocardial infarction or sudden death rate, 4.8/100 patient-years). Kaplan-Meier analysis showed a significantly higher percentage of patients free of major vascular events among patients treated with warfarin (p = 0.01). The relative risk of a major vascular event in those treated with warfarin was 0.46 (95% CI, 0.23 to 0.86) compared with patients treated with aspirin. Major hemorrhagic complications occurred in three patients on warfarin (including two deaths) during 166 patient-years of follow-up and in none of the patients on aspirin during 143 patient-years of follow-up. This study suggests a favorable risk/benefit ratio for warfarin compared with aspirin for the prevention of major vascular events in patients with symptomatic intracranial large-artery stenosis. A prospective, randomized study is needed to confirm these findings.