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2016 European Stroke Conference on Antithrombotic Thrombosis

2017-08-05

The European Stroke Conference (ESOC2016), held in Barcelona from May 10 to May 12, 2016, is highly informative in terms of antithrombotic, thrombolytic, and cerebral hemorrhage. SOCRATES antiplatelet therapy new drug evaluation: tegrelol in the prevention of acute ischemic stroke or TIA patients 90 days of stroke, myocardial infarction, death is not better than aspirin. The results of the SOCRATES study showed that the difference was not statistically significant (6.7% vs 7.5%, P = 0.07), although the number of major end points was less in the Tegrella group than in the aspirin group. Speakers at the conference, S. Claiborne Johnston, also said that it is not recommended to use tegrero for acute stroke or TIA patients. Although the results of the study is not satisfactory, and there are many people from the study of the population of our country, but from the overall proportion of the crowd, the Asian patients are still a minority, the results should be carefully interpreted. Subgroup analysis of Asian populations in this study will be published shortly. ENCHANTED tPA thrombolytic dose problem: After the use of low-dose tPA thrombolysis, compared with the standard dose of efficacy did not meet the non-inferiority criteria, but the lower the risk of bleeding. In the ENCHANTED study, the proportion of low-dose and standard-dose tPA deaths or disability at 90 days was 53.2% and 51.1%, respectively, beyond the upper limit of non-inferiority. The incidence of major symptomatic cerebral hemorrhage in both groups was 1.0% and 2.1%, respectively, showing a low dose of tPA safety. Of the study's population, Asians accounted for 63% of the population. However, since the efficacy of the study has not yet reached the end, the study evaluation is still mixed.IST-3 at different times to see thrombolysis: tPA treatment has early risk, but long-term follow-up results show that patients receiving thrombolytic therapy mortality decreased. IST-3 previous major findings were reported in 2012, the results show that tPA thrombolysis, 6 months after the functional outcome has improved. The data published for 3 years after the follow-up study data show that tPA thrombolytic therapy, the absolute mortality rate decreased by 3.6% (95% CI, -0.8% to 8.1%), and tPA treatment within 7 days after the survival of patients , The mortality rate at 3 years has decreased significantly. Some people suspect that tPA will have an impact on the long-term prognosis of survivors, this study confirms the fact that this is not the case.For patients, if you have an acute phase, then both the functional outcome or long-term survival rate, tPA can bring benefits.ATACH-II focused cerebral hemorrhage step-down target: systolic blood pressure of 110 ~ 139mmHg for the blood pressure target, 90 days of death or disability compared with the standard blood pressure was no significant difference, but can reduce hematoma enlargement. In the ATACH-II study, when the antihypertensive target was further limited to 110 to 139 mmHg, the incidence of end points was 38.7% and 37.7%, respectively, compared with the standard pressure drop of 140 to 179 mmHg, and the results were not statistically significant (P = 0.72). However, the study also confirmed that enhanced blood pressure can reduce the expansion of hematoma, hematoma expansion in both groups more than 33% of the proportion of patients were 18.9% and 24.4%. In 2013, the INTERACT2 study showed that patients with systolic blood pressure at baseline could benefit from hypotension, and the hypotension goal was to reduce the systolic blood pressure to 140 mmHg, and thereafter the guideline was recommended as a recommended antihypertensive target. These two studies together suggest that perhaps the best and most effective goal of post-cerebral hemorrhage is 140mmHg. PATCH antiplatelet patients after cerebral hemorrhage how to do: for the use of anti-platelet drugs in patients with cerebral hemorrhage, transfusion of platelets will lead to poor prognosis. PATCH research design and results are very strong and clear. The results showed that patients with platelet transfusion, death or independence were more likely to be more than the standard treatment group (odds ratio 2.05, 95% CI, 1.18 to 3.56), and at 3 months, the platelet transfusion group mRS Patients with a score of 4 to 6 accounted for more (72% vs 56%). For patients with cerebral hemorrhage who are using antiplatelet agents, the PATCH study confirms that this opportunistic approach is a clear and complete error. For patients, more treatment does not mean better recovery. This study once again reminds us that clinical work can not "take it for granted".

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