BACKGROUND: Atherosclerotic intracranial arterial stenosis is an important cau se of stroke. Warfarin is commonly used in preference to aspirin for this disord er, but these therapies have not been compared in a rando...BACKGROUND: Atherosclerotic intracranial arterial stenosis is an important cau se of stroke. Warfarin is commonly used in preference to aspirin for this disord er, but these therapies have not been compared in a randomized trial. METHODS: W e randomly assigned patients with transient ischemic attack or stroke caused by angiographically verified 50 to 99 percent stenosis of a major intracranial arte ry to receive warfarin (target international normalized ratio, 2.0 to 3.0) or as pirin (1300 mg per day) in a double-blind, multicenter clinical trial. The prim ary end point was ischemic stroke, brain hemorrhage, or death from vascular caus es other than stroke. RESULTS: After 569 patients had undergone randomization, e nrollment was stopped because of concerns about the safety of the patients who h ad been assigned to receive warfarin. During a mean follow-up period of 1.8 yea rs, adverse events in the two groups included death (4.3 percent in the aspirin group vs. 9.7 percent in the warfarin group; hazard ratio for aspirin relative t o warfarin, 0.46; 95 percent confidence interval, 0.23 to 0.90; P=0.02), major h emorrhage (3.2 percent vs. 8.3 percent, respectively; hazard ratio, 0.39; 95 per cent confidence interval, 0.18 to 0.84; P=0.01), and myocardial infarction or su dden death (2.9 percent vs. 7.3 percent, respectively; hazard ratio, 0.40; 95 pe rcent confidence interval, 0.18 to 0.91; P=0.02). The rate of death from vascula r causes was 3.2 percent in the aspirin group and 5.9 percent in the warfarin gr oup (P=0.16); the rate of death from nonvascular causes was 1.1 percent and 3.8 percent, respectively (P=0.05). The primary end point occurred in 22.1 percent o f the patients in the aspirin group and 21.8 percent of those in the warfarin gr oup (hazard ratio, 1.04; 95 percent confidence interval, 0.73 to 1.48; P=0.83). CONCLUSIONS: Warfarin was associated with significantly higher rates of adverse events and provided no benefit over aspirin in this trial. Aspirin should be use d in preference to warfarin for patients with intracranial arterial stenosis.展开更多
患者男,57岁,体重65 kg,因“突发昏迷3d”急诊入院.术前诊断：（1）小脑大面积梗死,脑积水.（2）重度退行性主动脉瓣狭窄合并轻中度关闭不全,心功能Ⅱ级.（3）冠状动脉粥样硬化性心脏病,三支病变,无症状性心肌缺血.（4）高血压3级,极高...患者男,57岁,体重65 kg,因“突发昏迷3d”急诊入院.术前诊断：（1）小脑大面积梗死,脑积水.（2）重度退行性主动脉瓣狭窄合并轻中度关闭不全,心功能Ⅱ级.（3）冠状动脉粥样硬化性心脏病,三支病变,无症状性心肌缺血.（4）高血压3级,极高危组.（5）发热待查.拟于静吸复合麻醉下急诊行“开颅去骨瓣减压＋脑室外引流＋气管切开术”.术前检查：浅昏迷,双侧瞳孔等大等圆,对光反射减弱.听诊主动脉瓣第一、二听诊区可闻及3/6级收缩期粗糙杂音,向颈部传导.头颅CT：小脑大面积梗死,脑积水.冠状动脉CT：冠状动脉粥样硬化,左前降支狭窄10％,左回旋支狭窄85％,右冠状动脉狭窄60％～ 70％.心脏瓣膜病,主动脉瓣损害,升主动脉增宽.心脏彩超：主动脉瓣重度狭窄伴轻中度关闭不全,升主动脉增宽;主动脉瓣口面积0.9 cm2,收缩期跨瓣压差86 mm Hg（1 mm Hg =0.133 kPa）,舒张期跨瓣压差101 mm Hg,左室饱满,左房扩大;室间隔、左室壁增厚,左室射血分数54％.患者因心脏病变准备行“主动脉瓣置换＋CABG＋升主动脉探查术”,术前突发昏迷,发热（T42℃）,故需急诊行开颅手术.化验检查：WBC 26.19×109/L.展开更多
脑血管病已成为危害中老年人身体健康及生命的主要疾病,其中缺血性脑卒中占脑血管病的比例〉70%[1],进展性脑卒中是急性缺血性脑卒中的一种特殊类型,一直是备受关注的临床问题。以往常将单发性皮质下小梗死（Single Small Subcortical I...脑血管病已成为危害中老年人身体健康及生命的主要疾病,其中缺血性脑卒中占脑血管病的比例〉70%[1],进展性脑卒中是急性缺血性脑卒中的一种特殊类型,一直是备受关注的临床问题。以往常将单发性皮质下小梗死（Single Small Subcortical Infarctions,SSSI）与腔隙性脑梗死混为一谈,后者被认为是由小动脉病变所致,主要以纤维蛋白样降解或脂质透明变性为病理特征,神经功能缺损相对受限[2];更多研究表明SSSI的病理机制还包括载体动脉粥样硬化性病变闭塞穿支动脉,展开更多
文摘BACKGROUND: Atherosclerotic intracranial arterial stenosis is an important cau se of stroke. Warfarin is commonly used in preference to aspirin for this disord er, but these therapies have not been compared in a randomized trial. METHODS: W e randomly assigned patients with transient ischemic attack or stroke caused by angiographically verified 50 to 99 percent stenosis of a major intracranial arte ry to receive warfarin (target international normalized ratio, 2.0 to 3.0) or as pirin (1300 mg per day) in a double-blind, multicenter clinical trial. The prim ary end point was ischemic stroke, brain hemorrhage, or death from vascular caus es other than stroke. RESULTS: After 569 patients had undergone randomization, e nrollment was stopped because of concerns about the safety of the patients who h ad been assigned to receive warfarin. During a mean follow-up period of 1.8 yea rs, adverse events in the two groups included death (4.3 percent in the aspirin group vs. 9.7 percent in the warfarin group; hazard ratio for aspirin relative t o warfarin, 0.46; 95 percent confidence interval, 0.23 to 0.90; P=0.02), major h emorrhage (3.2 percent vs. 8.3 percent, respectively; hazard ratio, 0.39; 95 per cent confidence interval, 0.18 to 0.84; P=0.01), and myocardial infarction or su dden death (2.9 percent vs. 7.3 percent, respectively; hazard ratio, 0.40; 95 pe rcent confidence interval, 0.18 to 0.91; P=0.02). The rate of death from vascula r causes was 3.2 percent in the aspirin group and 5.9 percent in the warfarin gr oup (P=0.16); the rate of death from nonvascular causes was 1.1 percent and 3.8 percent, respectively (P=0.05). The primary end point occurred in 22.1 percent o f the patients in the aspirin group and 21.8 percent of those in the warfarin gr oup (hazard ratio, 1.04; 95 percent confidence interval, 0.73 to 1.48; P=0.83). CONCLUSIONS: Warfarin was associated with significantly higher rates of adverse events and provided no benefit over aspirin in this trial. Aspirin should be use d in preference to warfarin for patients with intracranial arterial stenosis.
文摘患者男,57岁,体重65 kg,因“突发昏迷3d”急诊入院.术前诊断：（1）小脑大面积梗死,脑积水.（2）重度退行性主动脉瓣狭窄合并轻中度关闭不全,心功能Ⅱ级.（3）冠状动脉粥样硬化性心脏病,三支病变,无症状性心肌缺血.（4）高血压3级,极高危组.（5）发热待查.拟于静吸复合麻醉下急诊行“开颅去骨瓣减压＋脑室外引流＋气管切开术”.术前检查：浅昏迷,双侧瞳孔等大等圆,对光反射减弱.听诊主动脉瓣第一、二听诊区可闻及3/6级收缩期粗糙杂音,向颈部传导.头颅CT：小脑大面积梗死,脑积水.冠状动脉CT：冠状动脉粥样硬化,左前降支狭窄10％,左回旋支狭窄85％,右冠状动脉狭窄60％～ 70％.心脏瓣膜病,主动脉瓣损害,升主动脉增宽.心脏彩超：主动脉瓣重度狭窄伴轻中度关闭不全,升主动脉增宽;主动脉瓣口面积0.9 cm2,收缩期跨瓣压差86 mm Hg（1 mm Hg =0.133 kPa）,舒张期跨瓣压差101 mm Hg,左室饱满,左房扩大;室间隔、左室壁增厚,左室射血分数54％.患者因心脏病变准备行“主动脉瓣置换＋CABG＋升主动脉探查术”,术前突发昏迷,发热（T42℃）,故需急诊行开颅手术.化验检查：WBC 26.19×109/L.
文摘脑血管病已成为危害中老年人身体健康及生命的主要疾病,其中缺血性脑卒中占脑血管病的比例〉70%[1],进展性脑卒中是急性缺血性脑卒中的一种特殊类型,一直是备受关注的临床问题。以往常将单发性皮质下小梗死（Single Small Subcortical Infarctions,SSSI）与腔隙性脑梗死混为一谈,后者被认为是由小动脉病变所致,主要以纤维蛋白样降解或脂质透明变性为病理特征,神经功能缺损相对受限[2];更多研究表明SSSI的病理机制还包括载体动脉粥样硬化性病变闭塞穿支动脉,
