| Objective:To evaluate antiplatelet drugs on secondary prevention of stroke with Essen Stroke Risk Score (Essen Stroke Risk Score, ESRS); and investigate efficacy and safety of antiplatelet drugs in non-cardiogenic stroke patients under different Essen score.Methods:This research was retrospectively, continuously carried on the Neurology wards of Zhejiang University Second Affiliated Hospital, and all non-cardiac ischemic stroke patients were enrolled to investigate from January 2009 to December 2011. Telephone follow-up to patients or their families was finished in September 2015. The longest follow-up time was 6.7 years and the shortest’s was 3.7 years; the average follow-up time was 5.2 years. The kind of antiplatelet drugs used after dischareing, the usage rate of antiplatelet drugs, the incidence of vascular endpoint event (vascular death, stroke, myocardial infarction), the improvement of neurological function (modified RANKIN scale mRS score),the security of antiplatelet drugs(gastrointestinal reactions, bleeding)were recerded in the follow-up. According to the kind of antiplatelet drugs used after discharged, the patients were divided into Group aspirin and Group clopidogrel. According to Essen Stroke Risk Score, each group was further divided into three groups:Essen<3, Essen=3 and Essen>3. The efficacy and the adverse reactions of each group was analyzed.Results:1 There are 1175 non-cardiac ischemic stroke patients were enrolled in this research was,297 cases were lost in the follow-up, and the final effective cases was 878; the missing visit rate was 25.28 percent.2 About the endpoint of vascular stroke:when ESRS<3, Group aspirin was slightly higher than that of Group clopidogrel (10.60%:7.41%, P= 0.600), but there is no statistical difference between these groups; when ESRS= 3, Group clopidogrel was significantly higher than that of Group aspirin (24.00%:12.57%, P= 0.025); when ESRS> 3, Group aspirin was significantly higher than that of Group clopidogrel (27.39%:14.84%, P= 0.003).3 About neurological function (modified RANKIN scale mRS score) improved: when ESRS<3, there was no difference of mRS score improving between Group aspirin and Group clopidogrel (0.31±1.63:0.38±1.75, P=0.457); when ESRS=3, the mRS score decreasing of Group clopidogrel is greater than that of Group aspirin (0.35±1.79: 0.09±1.70, P=0.216), but there is no statistical difference between of them; when ESRS> 3, the mRS score decreasing of Group clopidogrel was significantly higher than that of Group aspirin (0.07±1.79:-0.32±1.88, P=0.003).4 About the usage rate of aspirin or clopidogrel in stroke patients:when ESRS<3, the discontinuation rate of Group clopidogrel was significantly higher than that of Group aspirin (51.85%:25.83%, P= 0.006); when ESRS= 3, the discontinuation rate of Group clopidogrel was higher than that of Group aspirin (28.00%:16.77%, P= 0.044); when ESRS> 3, there is no significant difference between the discontinuation rate of Group aspirin and Group clopidogrel (13.20%:14.84%, P= 0.630). Further explored of discontinuation reasons of adverse events, Group aspirin was significantly higher than that of Group clopidogrel (57.94%:32.76%, P= 0.002); being of no referral or self-withdrawal, the discontinuation reasons of Group clopidogrel was significantly higher than that of Group aspirin (44.83%:27.10%, P= 0.021). Further to analyze the drug withdrawal time, when it happened in 1 year, Group clopidogrel was significantly higher than that of Group aspirin (50.55%:28.04%, P= 0.005); when happened in 4-5 years, Group aspirin was significantly higher than that of Group clopidogrel (35.51%: 12.07%, P= 0.001).5 About the safety of aspirin or clopidogrel used stroke patients:when ESRS<3, the adverse reactions rates of Group aspirin was higher than that Group clopidogrel (13.25%:7.41%, P= 0.369),but there is no statistical difference between of them;when ESRS= 3, the adverse reactions rates of Group aspirin was higher than that of Group clopidogrel (12.57%:8.00%, P= 0.296), but there is no statistical difference between of them; when ESRS> 3, there was no difference of adverse reactions rates between Group aspirin and Group clopidogrel (6.93%:7.10%, P= 0.947).6 To further explore multivariate variables analysis:when ESRS<3, the drug withdrawal rate of antiplatelet drugs [OR= 3.471,95% CI (1.222,9.859), P= 0.019] was the independent factor of stroke recurrence; when ESRS= 3, the antiplatelet drug selection of aspirin or clopidogrel [OR= 0.432,95% CI (0.229,0.814), P= 0.009] and the drug withdrawal rate of antiplatelet drugs [OR= 2.063,95% CI (1.103,3.859), P= 0.023] were the independent factors of stroke recurrence; when ESRS> 3, the antiplatelet drug selection of aspirin or clopidogrel [OR= 2.035,95% CI (1.208,3.430), P= 0.008] and the drug withdrawal rate of antiplatelet drugs [OR= 2.415,95% CI (1.119,5.214), P= 0.025] were the independent factors of stroke recurrence.Conclusions:1 When ESRS<3, the drug withdrawal rate of Group aspirin was significantly lower than that of Group clopidogrel, but there is no difference in the vascular endpoint event, neurological function improving, safety between in these two groups. Thus, choosing aspirin for secondary prevention of stroke compared is more appropriate to clopidogrel.2 When ESRS= 3, the vascular endpoint event of Group aspirin was significantly lower than that of Group clopidogrel, the drug withdrawl rate of Group aspirin was significantly lower than that of Group clopidogrel, but there were no difference neurological function improving and the safety between of them, Thus, choosing aspirin for secondary prevention of stroke is more appropriate to clopidogrel.3 When ESRS> 3, the incidence of vascular endpoint event of Group clopidogrel was significantly lower than that of Group aspirin, and the neurological function improving was significantly better than that of Group aspirin, but there is no difference of the usage rate and the safety between of these two drugs, Thus, choosing clopidogrel for secondary prevention of stroke is more appropriate than aspirin. |
PDF Full Text Request