RESUMEN
INTRODUCTION: Clopidogrel resistance causes recurrent stroke. However, outcomes of modified antiplatelet medications to prevent recurrent ischemic stroke are not well known. METHODS: Patients who received clopidogrel with and without modification as initial treatment for stroke were recruited and compared. The primary outcome was ischemic stroke and myocardial infarction at the 1-year follow-up. The secondary outcome was bleeding complications. RESULTS: Overall, 206 patients treated with clopidogrel were enrolled and were divided into the modification (n = 39) and no modification (n = 167) groups. There was a significant difference in the incidence of severe cerebral arterial stenosis between the two groups (modification group, 16/39, 41.03%; no modification group, 36/167, 21.56%, P = 0.012) at baseline. The loss to follow-up rate was 12.14% (25/206). After adjustment for severe cerebral artery stenosis, antiplatelet modification based on the platelet reactivity unit (PRU) value significantly improved in the per protocol set (odds ratio 0.142, 95% confidential interval 0.022-0.898, P = 0.038). The area under the curve of the different PRU cutoff values were 0.630, 0.605, and 0.591 (P = 0.016, 0.051, and 0.092) for PRU 190, 208, and 235, respectively. CONCLUSION: Verifynow P2Y12 PRU-guided modification of clopidogrel for ischemic stroke significantly improved or prevented recurrence at the 1-year follow-up. Our findings suggest that clopidogrel therapy based on the PRU cutoff value of 190 should be considered to improve outcomes. TRIAL REGISTRATION: ClinicalTrials.gov NCT02618265 (December 1, 2015).
RESUMEN
BACKGROUND: Real-world studies have indicated that adherence is important for guaranteeing medication effectiveness. Few studies have tested the feasibility and efficacy of WeChat-based improvement services, via mobile phone, in secondary prevention-specific follow-up among discharged stroke patients. OBJECTIVE: We evaluated a quadruple-domain, WeChat-based service for ischemic stroke secondary prevention designed to improve treatment adherence of discharged patients. This service focuses on sending reminders for drug use, blood pressure recording, and glucose recording; it also records medication use. We compared the endpoint event rate between WeChat self-monitoring and traditional monitoring. METHODS: A cohort study was used to determine the feasibility of a physician-assisted, WeChat-based improvement service and follow-up self-monitoring platform for the secondary prevention of ischemic stroke. The platform was developed by the Peking University Third Hospital based on the information-motivation-behavioral skills model. The overall adherence rate was calculated as the proportion of medication doses verified via uploading. The ischemic endpoint event rate and medication noncompliance rate were compared between traditional prevention monitoring and WeChat self-monitoring. Factors influencing adherence were summarized. RESULTS: The 1-year follow-up event rate of the WeChat self-monitoring group was 11.9% (12/101), which was less than that of the traditional group (21/157, 13.4%). Compared with the traditional group, the risk ratio of the WeChat group was 0.983 (95% CI 0.895-1.080); this difference was not noted to be significant. The 1-year medication noncompliance ratio tended to be lower in the WeChat monitoring group (3/101, 3.0%) than in the traditional group (11/157, 7.0%; χ2=1.9, df=1, P=.16). Of the platform registry participants, 89.7% (210/234: 167 hospital-based and 43 community-based participants) adhered to inputting information into WeChat for 8-96 weeks. The average adherence time was 16.54 (SD 0.80, range 2-24) months. The average decrease in adherence was 4 participants (1.1%) per month. Being a member of a community-based population was an influencing factor for good adherence at the 2-year follow-up (OR 2.373, 95% CI 1.019-5.527, P=.045), whereas transient ischemic attack was an influencing factor for poor adherence at the 2-year follow-up (OR 0.122, 95% CI 0.016-0.940, P=.04). CONCLUSIONS: Use of WeChat self-monitoring showed a trend of increasing medication compliance and decreasing ischemic endpoint event rate compared with traditional monitoring. However, there were ceiling effects in the outcomes, and a relatively small sample size was used. Male participants displayed better adherence to WeChat self-monitoring. The community-based population displayed good adherence when using WeChat self-monitoring. TRIAL REGISTRATION: ClinicalTrials.gov NCT02618265; https://clinicaltrials.gov/ct2/show/NCT02618265.
Asunto(s)
Isquemia Encefálica , Teléfono Celular , Accidente Cerebrovascular Isquémico , Accidente Cerebrovascular , Isquemia Encefálica/tratamiento farmacológico , Isquemia Encefálica/prevención & control , Estudios de Cohortes , Humanos , Masculino , Alta del Paciente , Prevención Secundaria , Accidente Cerebrovascular/tratamiento farmacológico , Accidente Cerebrovascular/prevención & controlRESUMEN
[This corrects the article DOI: 10.2196/16496.].
RESUMEN
OBJECTIVE: To study the relationship between smoking and hyperhomocysteinemia (HHe) in ischemic stroke patients. METHODS: The clinical data of 329 ischemic stroke patients with HHe and 306 age-matched ischemic stroke patients without HHe, including sex, symptoms, signs, history of smoking, and plasma homocysteine (Hcy), folate, and vitamin B(12) concentrations were compared. The ischemic stroke lesions were divided into 2 subtypes: large vessel disease group and small vessel disease group according to the TOAST system. RESULT: The number of cigarettes smoked per day, cumulative year of smoking, and smoking index (number of cigarettes smoked per day X cumulative year of smoking), and ratio of males of the HHe group were all significantly higher than those of the non-HHe group, and the plasma homocysteine, folate, and vitamin B(12) concentrations of the HHe group were all significantly lower than those of the non-HHe group (all P < 0.01). Smoking index was positively correlated with the Hcy concentrations and negatively correlated with the folate and vitamin B(12) concentrations (all P < 0.01). The smoking proportion and Hcy concentration of the male patients were significantly higher than those of the female patients (both P < 0.01), and the plasma folate and vitamin B(12) concentrations of the male patients were all significantly lower than those of the female patients (P < 0.01 and P < 0.05). The number of cigarettes smoked per day, cumulative year of smoking, smoking index, and Hcy concentration of the large vessel disease group were all significantly higher than those of the small vessel disease group (all P < 0.01). CONCLUSION: Smoking and being male may be the risk factors of HHe in ischemic stroke patients. Smoking and HHe are prone to cause lesion in large vessel.