뇌졸중 최신지견 2009: 뇌졸중의 급성기 치료 및 이차예방
Stroke Update 2009: Acute Ischemic Stroke and Secondary Stroke Prevention
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초록
There were several positive clinical trials with new anticoagulants and antiplatelet agents which will affect on the guideline of the secondary stroke prevention. Dabigatran, an oral direct thrombin inihibitor, had better clinical outcomes than warfarin in the prevention of cardiovascular events in the patients with atrial fibrillation. Ticagrelor and prasugrel are new antiplatelet agents. They successfully reduced cardiovascular events after acute myocardial infarction without increase bleeding complications compared to clopidogrel. The effects of platelet inhibition of those thienopyridine antiplatelet agents were influenced by the usage of proton pump inhibitor owever, there are no direct supporting evidences to avoid concomitant use of prohibition of proton pump inhibitors and thienopyridines. Genetic polymorphisms of cytochrome P450 2C19, which affects on the metabolism of thienopyridines, affect on the antiplatelet effects of thienopyridines and clinical outcomes. One small clinical trial showed that niacin was better in the prevention of progression of intima-medial thickness of common carotid artery than ezetimibe.
Abstract
There were several positive clinical trials with new anticoagulants and antiplatelet agents which will affect on the guideline of the secondary stroke prevention. Dabigatran, an oral direct thrombin inihibitor, had better clinical outcomes than warfarin in the prevention of cardiovascular events in the patients with atrial fibrillation. Ticagrelor and prasugrel are new antiplatelet agents. They successfully reduced cardiovascular events after acute myocardial infarction without increase bleeding complications compared to clopidogrel. The effects of platelet inhibition of those thienopyridine antiplatelet agents were influenced by the usage of proton pump inhibitor owever, there are no direct supporting evidences to avoid concomitant use of prohibition of proton pump inhibitors and thienopyridines. Genetic polymorphisms of cytochrome P450 2C19, which affects on the metabolism of thienopyridines, affect on the antiplatelet effects of thienopyridines and clinical outcomes. One small clinical trial showed that niacin was better in the prevention of progression of intima-medial thickness of common carotid artery than ezetimibe.
참고문헌 (16)
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