2006 Fiscal Year Final Research Report Summary
Antithrombotic therapy for secondary prevention in ischemic stroke patients with antiphospholipid syndrome
| Project/Area Number |
16590849
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| Research Category |
Grant-in-Aid for Scientific Research (C)
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| Allocation Type | Single-year Grants |
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| Section | 一般 |
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| Research Field |
Neurology
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| Research Institution | Tokai University |
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Principal Investigator |
KITAGAWA Yasuhisa Tokai University, School of Medicine, Assistant Professor, 医学部, 教授 (30124944)
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| Co-Investigator(Kenkyū-buntansha) |
KAMETSU Yutaka Tokai University, School of Medicine, Assistant Professor, 医学部, 講師 (30233977)
SEKIYAMA Sari Tokai University, School of Medicine, Assistant Professor, 医学部, 講師 (40276811)
OKUMA Naohiro Tokai University, School of Medicine, Assistant Professor, 医学部, 講師 (50307005)
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| Project Period (FY) |
2004 – 2006
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| Keywords | antiphospholipid antibody / stroke / anticoagulation therapy / antiplatelet therapy / secondary prevention / anticardiolipin antibody / lupus anticoagulant / Activated plate |
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| Research Abstract |
Antiphospholipid antibody was considered to be a risk factor for ischemic stroke. Among the various antiphospholipid antibodies, β2-GPI dependent anticardiolipin antibody and lupus anticoagulant were important. We examined the incidence of these antibodies in 250 ischemic stroke patients. β2-GPI dependent anticardiolipin antibody was 2.8% and lupus anticoagulant was 9.2%. Antithrombotic therapy for secondary prevention of ischemic stroke in patients with antiphospholipid syndrome (APS) remains controversial. We therefore compared single antiplatelet therapy and a combination of antiplatelet and anticoagulation therapy for secondary prevention in ischemic stroke patients with APS
The subjects were 20 ischemic stroke patients with antiphosholipid antibody (10 males and 10 females, mean age 48 years), 13 with primary antiphospholipid syndrome and 7 with SLE-related antiphospholipid syndrome. Diagnosis of APS was based on the 1998 Sapporo Criteria. Patients ware assigned to either single an
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tiplatelet therapy (aspirin 100 mg or ticlopidine 200 mg) or a combination of antiplatelet and anticoagulation therapy (INR : 2.0-3.0 ; mean 2.4±0.3) for the secondary prevention of stroke. There was no significant difference between the two groups in age, gender, NIHSS on admission, mRS at discharge, or rates of hypertension, diabetes mellitus, hyperlipidemia, and cardiac disease. We examined the Kaplan-Meier survival curves in each treatment. The primary outcome was the occurrence of stroke. The mean follow-up time was 3.9±2.0 years. The cumulative incidence of stroke in patients with single antiplatelet treatment was statistically significantly higher than that in patients receiving the combination of antiplatelet and anticoaglation therapy (log-rank test, p-value=0.026). The incidence of hemorrhagic complications was similar in the two groups. The recent APASS study did not show any difference in effectiveness for secondary prevention between single antiplatelet (aspirin) and single anticoagulant (warfarin) therapy. Our results indicate that combination therapy may be more effective in APS-related ischemic stroke. Less
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