Progress in Drugs Therapy for Non-disabling Ischemic Cerebrovascular Events

doi:10.3969/j.issn.1673-5765.2022.04.015

Abstract

Abstract: The non-disabling ischemic cerebrovascular events (NICE) accounted for 50%- 60% of ischemic cerebrovascular diseases. In recent years, the treatment of NICE has made a major breakthrough from the initial mono anti-platelet therapy to double anti-platelet therapy (DAPT), and the previous studies suggested that the short-course DAPT for 21 days had higher efficacy and safety. Intravenous thrombolysis for NICE can increase the risk of bleeding, so it is still controversial whether NICE patients should receive thrombolysis. The NICE type, NIHSS score, thrombolysis time window and drug dose are influencing factors for thrombolysis. For NICE patients carrying CYP2C19 LOF gene, ticagrelor has better therapeutic effect than clopidogrel. In addition, polymorphism of other genes also has an impact on the prognosis of NICE. The research on gene polymorphism may become a new direction for stroke treatment in the future.

Key words: Non-disabling ischemic cerebrovascular event; Ischemic stroke; Transient ischemic attack; Aspirin; Clopidogrel; Antiplatelet therapy; Thrombolysis

摘要： 非致残性缺血性脑血管事件（non-disabling ischemic cerebrovascular events，NICE）占缺血性脑血管病的50%～60%。近年来，NICE的治疗从最初的单药抗血小板到双联抗血小板取得了重大突破，研究证明21 d的短程、双联抗血小板方案具有更高的有效性和安全性。NICE患者进行溶栓治疗获益的同时会增加出血风险，目前对于NICE患者是否需要接受溶栓治疗仍存在争议，但可预知的是，NICE的类型、NIHSS评分、溶栓时间窗、药物剂量等可作为后续研究设计考虑的影响因素。对于携带 CYP2C19 LOF基因的NICE患者，接受替格瑞洛治疗的预后效果明显优于氯吡格雷；另外，其他基因的多态性对NICE的预后也存在较大影响，基因多态性研究或成为未来卒中治疗的一个新方向。

关键词: 非致残性缺血性脑血管事件; 缺血性卒中; 短暂性脑缺血发作; 阿司匹林; 氯吡格雷; 抗血小板治疗; 溶栓

LI Zhenhua, LIU Zhu, HU Quanzhong. Progress in Drugs Therapy for Non-disabling Ischemic Cerebrovascular Events[J]. Chinese Journal of Stroke, 2022, 17(04): 407-412.

李振华, 刘著, 胡全忠. 非致残性缺血性脑血管事件药物治疗进展[J]. 中国卒中杂志, 2022, 17(04): 407-412.

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