Stroke:西洛他唑用于卒中和认知功能下降的二级预防

2020-07-12 MedSci原创 MedSci原创

西洛他唑可以有效长期预防复发性卒中,而不会增加出血的风险。但是,大多数与亚太地区患者有关的试验以及西方国家的更多试验应评估其对认知功能下降、功能结局和耐受性的影响。

西洛他唑是磷酸二酯酶3'抑制剂,在亚太地区的国家中被用于预防卒中,但在其他地区很少使用。除抗血小板作用较弱外,它还可在实验室模型中稳定内皮细胞,有助于髓鞘修复和星形胶质细胞-神经元能量转移,这些作用可能有利于预防小血管疾病的进展。近日,心血管疾病领域权威杂志Stroke上发表了一篇研究文章,研究人员对西洛他唑预防卒中、认知功能减退或放射性小血管疾病病变进展的无混淆随机对照试验进行了系统评价和荟萃分析。

两名研究者检索了论文(2019年1月1日至2019年7月16日)并提取了数据。研究人员通过敏感性分析计算了复发性缺血、出血性卒中、死亡、不良症状的Peto比值比(ORs)和95%CI。该系统评论已注册(CRD42018084742)。

研究人员纳入了20项随机对照试验(n=10505),18项缺血性卒中试验(总n=10449)和2项认知障碍试验(n=56);大多数试验在亚太国家完成。与安慰剂、阿司匹林或氯吡格雷相比,西洛他唑降低了复发性缺血性卒中(17项试验,n=10225,OR=0.68 [95%CI为0.57-0.81];P<0.0001)、出血性卒中(16项试验,n=9736,OR=0.43[95%CI为0.29–0.64];P=0.0001)、死亡(OR=0.64 [95%CI为0.49–0.83],P<0.0009)、全身性出血(n=8387,OR=0.73 [95%CI为0.54-0.99];P=0.04)的风险,但头痛发生率增加。长期(>6个月)西洛他唑治疗可减少复发性缺血性卒中,而短期治疗则不会增加出血。该分析的数据不足以评估对认知、影像学、功能结局或耐受性的影响。

由此可见,西洛他唑可以有效长期预防复发性卒中,而不会增加出血的风险。但是,大多数与亚太地区患者有关的试验以及西方国家的更多试验应评估其对认知功能下降、功能结局和耐受性的影响。

原始出处:

Caroline McHutchison,et al.Cilostazol for Secondary Prevention of Stroke and Cognitive Decline Systematic Review and Meta-Analysis.stroke.2020.https://www.ahajournals.org/doi/10.1161/STROKEAHA.120.029454

版权声明:
本网站所有内容来源注明为“梅斯医学”或“MedSci原创”的文字、图片和音视频资料,版权均属于梅斯医学所有。非经授权,任何媒体、网站或个人不得转载,授权转载时须注明来源为“梅斯医学”。其它来源的文章系转载文章,或“梅斯号”自媒体发布的文章,仅系出于传递更多信息之目的,本站仅负责审核内容合规,其内容不代表本站立场,本站不负责内容的准确性和版权。如果存在侵权、或不希望被转载的媒体或个人可与我们联系,我们将立即进行删除处理。
在此留言
评论区 (5)
#插入话题
  1. [GetPortalCommentsPageByObjectIdResponse(id=2034333, encodeId=053b20343333d, content=<a href='/topic/show?id=2fda91215d2' target=_blank style='color:#2F92EE;'>#认知功能下降#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=91215, encryptionId=2fda91215d2, topicName=认知功能下降)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=920c231, createdName=lixiaol, createdTime=Sat Nov 07 05:41:39 CST 2020, time=2020-11-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=802988, encodeId=410780298874, content=学习 学习 , beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM6DGOvNrRdcib3UmzMgpEQpl0ENSJScphsFtdgfibXX1g1IuEYGCjP23UqCd52TxTpSZibtPiclyusaHicnNXd78alaia19Qy1nAFo18/0, createdBy=50381491660, createdName=zwjnj2, createdTime=Thu Jul 16 14:14:03 CST 2020, time=2020-07-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1026674, encodeId=b0e210266e4cb, content=卒中虽然是临床上常见病,溶栓,取栓等血管内治疗也很成熟,但是仍然有很多未知问题有待认知!, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=健健, createdTime=Sun Jul 12 18:41:39 CST 2020, time=2020-07-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=802599, encodeId=798e80259933, content=<a href='/topic/show?id=8cc49051e18' target=_blank style='color:#2F92EE;'>#西洛他唑#</a>目前还很难成为主流, beContent=null, objectType=article, channel=null, level=null, likeNumber=99, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=90517, encryptionId=8cc49051e18, topicName=西洛他唑)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=lovetcm, createdTime=Sun Jul 12 18:22:43 CST 2020, time=2020-07-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=802593, encodeId=88a980259358, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=101, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6EF3hKja8nER8RMzxQdria9eCYFhgLTLsDOeqnvIYdeLDz5eP6EnicLuE5gibiawgno4zUA0jAR7Nbtp2llQ9fs3Mk/0, createdBy=278f1986883, createdName=医鸣惊人, createdTime=Sun Jul 12 16:58:20 CST 2020, time=2020-07-12, status=1, ipAttribution=)]
  2. [GetPortalCommentsPageByObjectIdResponse(id=2034333, encodeId=053b20343333d, content=<a href='/topic/show?id=2fda91215d2' target=_blank style='color:#2F92EE;'>#认知功能下降#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=91215, encryptionId=2fda91215d2, topicName=认知功能下降)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=920c231, createdName=lixiaol, createdTime=Sat Nov 07 05:41:39 CST 2020, time=2020-11-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=802988, encodeId=410780298874, content=学习 学习 , beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM6DGOvNrRdcib3UmzMgpEQpl0ENSJScphsFtdgfibXX1g1IuEYGCjP23UqCd52TxTpSZibtPiclyusaHicnNXd78alaia19Qy1nAFo18/0, createdBy=50381491660, createdName=zwjnj2, createdTime=Thu Jul 16 14:14:03 CST 2020, time=2020-07-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1026674, encodeId=b0e210266e4cb, content=卒中虽然是临床上常见病,溶栓,取栓等血管内治疗也很成熟,但是仍然有很多未知问题有待认知!, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=健健, createdTime=Sun Jul 12 18:41:39 CST 2020, time=2020-07-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=802599, encodeId=798e80259933, content=<a href='/topic/show?id=8cc49051e18' target=_blank style='color:#2F92EE;'>#西洛他唑#</a>目前还很难成为主流, beContent=null, objectType=article, channel=null, level=null, likeNumber=99, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=90517, encryptionId=8cc49051e18, topicName=西洛他唑)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=lovetcm, createdTime=Sun Jul 12 18:22:43 CST 2020, time=2020-07-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=802593, encodeId=88a980259358, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=101, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6EF3hKja8nER8RMzxQdria9eCYFhgLTLsDOeqnvIYdeLDz5eP6EnicLuE5gibiawgno4zUA0jAR7Nbtp2llQ9fs3Mk/0, createdBy=278f1986883, createdName=医鸣惊人, createdTime=Sun Jul 12 16:58:20 CST 2020, time=2020-07-12, status=1, ipAttribution=)]
    2020-07-16 zwjnj2

    学习 学习

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=2034333, encodeId=053b20343333d, content=<a href='/topic/show?id=2fda91215d2' target=_blank style='color:#2F92EE;'>#认知功能下降#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=91215, encryptionId=2fda91215d2, topicName=认知功能下降)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=920c231, createdName=lixiaol, createdTime=Sat Nov 07 05:41:39 CST 2020, time=2020-11-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=802988, encodeId=410780298874, content=学习 学习 , beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM6DGOvNrRdcib3UmzMgpEQpl0ENSJScphsFtdgfibXX1g1IuEYGCjP23UqCd52TxTpSZibtPiclyusaHicnNXd78alaia19Qy1nAFo18/0, createdBy=50381491660, createdName=zwjnj2, createdTime=Thu Jul 16 14:14:03 CST 2020, time=2020-07-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1026674, encodeId=b0e210266e4cb, content=卒中虽然是临床上常见病,溶栓,取栓等血管内治疗也很成熟,但是仍然有很多未知问题有待认知!, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=健健, createdTime=Sun Jul 12 18:41:39 CST 2020, time=2020-07-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=802599, encodeId=798e80259933, content=<a href='/topic/show?id=8cc49051e18' target=_blank style='color:#2F92EE;'>#西洛他唑#</a>目前还很难成为主流, beContent=null, objectType=article, channel=null, level=null, likeNumber=99, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=90517, encryptionId=8cc49051e18, topicName=西洛他唑)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=lovetcm, createdTime=Sun Jul 12 18:22:43 CST 2020, time=2020-07-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=802593, encodeId=88a980259358, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=101, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6EF3hKja8nER8RMzxQdria9eCYFhgLTLsDOeqnvIYdeLDz5eP6EnicLuE5gibiawgno4zUA0jAR7Nbtp2llQ9fs3Mk/0, createdBy=278f1986883, createdName=医鸣惊人, createdTime=Sun Jul 12 16:58:20 CST 2020, time=2020-07-12, status=1, ipAttribution=)]
    2020-07-12 健健

    卒中虽然是临床上常见病,溶栓,取栓等血管内治疗也很成熟,但是仍然有很多未知问题有待认知!

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=2034333, encodeId=053b20343333d, content=<a href='/topic/show?id=2fda91215d2' target=_blank style='color:#2F92EE;'>#认知功能下降#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=91215, encryptionId=2fda91215d2, topicName=认知功能下降)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=920c231, createdName=lixiaol, createdTime=Sat Nov 07 05:41:39 CST 2020, time=2020-11-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=802988, encodeId=410780298874, content=学习 学习 , beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM6DGOvNrRdcib3UmzMgpEQpl0ENSJScphsFtdgfibXX1g1IuEYGCjP23UqCd52TxTpSZibtPiclyusaHicnNXd78alaia19Qy1nAFo18/0, createdBy=50381491660, createdName=zwjnj2, createdTime=Thu Jul 16 14:14:03 CST 2020, time=2020-07-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1026674, encodeId=b0e210266e4cb, content=卒中虽然是临床上常见病,溶栓,取栓等血管内治疗也很成熟,但是仍然有很多未知问题有待认知!, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=健健, createdTime=Sun Jul 12 18:41:39 CST 2020, time=2020-07-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=802599, encodeId=798e80259933, content=<a href='/topic/show?id=8cc49051e18' target=_blank style='color:#2F92EE;'>#西洛他唑#</a>目前还很难成为主流, beContent=null, objectType=article, channel=null, level=null, likeNumber=99, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=90517, encryptionId=8cc49051e18, topicName=西洛他唑)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=lovetcm, createdTime=Sun Jul 12 18:22:43 CST 2020, time=2020-07-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=802593, encodeId=88a980259358, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=101, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6EF3hKja8nER8RMzxQdria9eCYFhgLTLsDOeqnvIYdeLDz5eP6EnicLuE5gibiawgno4zUA0jAR7Nbtp2llQ9fs3Mk/0, createdBy=278f1986883, createdName=医鸣惊人, createdTime=Sun Jul 12 16:58:20 CST 2020, time=2020-07-12, status=1, ipAttribution=)]
    2020-07-12 lovetcm

    #西洛他唑#目前还很难成为主流

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=2034333, encodeId=053b20343333d, content=<a href='/topic/show?id=2fda91215d2' target=_blank style='color:#2F92EE;'>#认知功能下降#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=91215, encryptionId=2fda91215d2, topicName=认知功能下降)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=920c231, createdName=lixiaol, createdTime=Sat Nov 07 05:41:39 CST 2020, time=2020-11-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=802988, encodeId=410780298874, content=学习 学习 , beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM6DGOvNrRdcib3UmzMgpEQpl0ENSJScphsFtdgfibXX1g1IuEYGCjP23UqCd52TxTpSZibtPiclyusaHicnNXd78alaia19Qy1nAFo18/0, createdBy=50381491660, createdName=zwjnj2, createdTime=Thu Jul 16 14:14:03 CST 2020, time=2020-07-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1026674, encodeId=b0e210266e4cb, content=卒中虽然是临床上常见病,溶栓,取栓等血管内治疗也很成熟,但是仍然有很多未知问题有待认知!, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=健健, createdTime=Sun Jul 12 18:41:39 CST 2020, time=2020-07-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=802599, encodeId=798e80259933, content=<a href='/topic/show?id=8cc49051e18' target=_blank style='color:#2F92EE;'>#西洛他唑#</a>目前还很难成为主流, beContent=null, objectType=article, channel=null, level=null, likeNumber=99, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=90517, encryptionId=8cc49051e18, topicName=西洛他唑)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=lovetcm, createdTime=Sun Jul 12 18:22:43 CST 2020, time=2020-07-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=802593, encodeId=88a980259358, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=101, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6EF3hKja8nER8RMzxQdria9eCYFhgLTLsDOeqnvIYdeLDz5eP6EnicLuE5gibiawgno4zUA0jAR7Nbtp2llQ9fs3Mk/0, createdBy=278f1986883, createdName=医鸣惊人, createdTime=Sun Jul 12 16:58:20 CST 2020, time=2020-07-12, status=1, ipAttribution=)]
    2020-07-12 医鸣惊人

    学习

    0

相关资讯

Circulation:冠脉搭桥术中结扎左心耳对房颤患者短期预后的影响

心房颤动导致的卒中,90%以上的血栓起源于左心耳,封堵左心耳是否可减少房颤患者的卒中率?

Neurology:卒中前二甲双胍使用、卒中严重程度和溶栓结局的相关性

受MET治疗的糖尿病卒中患者接受IVT治疗后入院时的卒中严重程度较轻,而3个月时的功能预后较好。这表明MET具有卒中保护效应。

Stroke:卒中溶栓每分钟都很重要

由此可见,改善DNT是卒中后取得良好疗效的关键因素。

进口干细胞治疗卒中的临床试验在北京天坛医院启动

2020年7月6日,九芝堂美科与北京天坛医院正式签署临床试验合作协议,标志着中国首个进口干细胞新药临床试验即将启动,适应症为“缺血性卒中”。

Neurology:卒中和心脏以上动脉粥样硬化患者的抗血栓治疗

与抗血小板治疗相比,抗凝治疗的卒中和心脏以上动脉粥样硬化患者没有缺血性卒中复发的风险,而大出血风险增加。

Stroke:卒中后焦虑症的远程医学认知行为疗法

研究人员从当前研究中获得的初步可行性数据支持进行更大的确定性临床试验,并在焦虑的卒中幸存者中使用腕戴式活动记录仪。