2022 台灣版高血脂治療指引-針對心血管疾病高風險族群 6. Ischemic stroke/TIA -STATIN

2025-12-09 14:10

2022 focused update of the 2017 Taiwanlipid guidelines for high risk patients:Coronary artery disease, peripheral arterydisease and ischemic stroke

下面中文使用google自動翻譯

缺血性中風/短暫性腦缺血發作

他汀類藥物用於急性中風

根據台灣中風登記處2006年至2008年間30,599例中風入院病例的數據，台灣絕大多數中風事件（>70%）為缺血性中風。在缺血性中風或短暫性腦缺血發作（TIA）患者中，高血壓（79.2%）和血脂異常（49.4%）是兩個最常見的危險因子。 ²⁹ 多項大型臨床研究探討了入院期間他汀類藥物治療對中風患者的影響。一項研究分析了2000年1月至2007年12月期間加州一家大型綜合醫療保健系統中12,689例缺血性中風入院患者的病歷。 ³¹ 研究發現，入院前和住院期間使用他汀類藥物與較高的存活率有關。相反，在住院期間停用他汀類藥物的患者死亡風險更高。住院期間使用較高劑量和更早開始使用他汀類藥物的益處更大。同樣，台灣中風登記處和GWTG中風登記處也顯示，在急性缺血性中風患者住院期間早期開始他汀類藥物治療具有有益效果。 31,32 此外，一項隨機臨床試驗招募了215名在缺血性中風後24小時內入院的患者和89名在中風前服用他汀類藥物的患者，並將他們進一步隨機分配到入院後前3天停用他汀類藥物組（n=46）或立即恢復服用阿托伐他汀20毫克/天組（n=43）。結果顯示，停用他汀類藥物的患者在3個月時功能預後不良的發生率較高，最終梗塞體積較大，且急性期早期神經功能惡化的風險較高。 ³³ 統合分析的結果進一步支持了住院期間早期啟動他汀類藥物治療，以及入院後不停用中風前服用的他汀類藥物的理念。 ³⁴ 此統合分析研究也表明，在接受溶栓治療的患者中，中風前服用他汀類藥物與良好的功能預後相關，儘管症狀性出血性轉化的風險增加。

推薦

對於急性缺血性中風或 TIA 且 LDLC 為 100 mg/dL 的患者，建議處方他汀類藥物（COR I，LOE A）。

對於在中風前已服用他汀類藥物的患者，在因急性缺血性中風或 TIA 入院後繼續服用他汀類藥物是合理的（COR IIa，LOE B）。

Ischemic stroke/TIA

Statins in acute stroke

According to the data from Taiwan Stroke Registry with 30,599 stroke admissions between 2006 and 2008, the majority of stroke events (>70%) were ischemic in Taiwan. Among patients with ischemic stroke or TIA, hypertension (79.2%) and dyslipidemia (49.4%) were the two most prevalent risk factors.29 Several large-scale clinical studies investigated the effect of statin treatment in stroke patients during admission. One study analyzed medical records from 12,689 patients admitted with ischemic stroke from a large integrated healthcare delivery system in California between January 2000 and December 2007.30 Statin used before and during hospitalization was associated with a better survival rate. On the contrary, patients who underwent statin withdrawal in the hospital had a greater risk of death. The benefit was greater for higher statin dose and earlier initiation during stroke admission. Similarly, the beneficial effects of early initiation of statin therapy during hospitalization in patients with acute ischemic stroke were also shown in the Taiwan Stroke Registry and GWTG-Stroke Registry.31,32 Moreover, one randomized clinical trial recruiting 215 patients admitted within 24 h of ischemic stroke and 89 patients having statins before stroke were further assigned either to statin withdrawal for the first 3 days after admission (n Z 46) or to immediately resumed atorvastatin 20 mg/day (n Z 43). The results showed that patients with statin withdrawal had a higher frequency of poor functional outcome at 3 months, greater final infarct volume and higher risk of early neurological deterioration at acute stage.33 The concept of early initiation of statin during hospitalization and do not withdrawal pre-stroke statin after admission was further supported by results of meta-analysis.34 The meta-analysis study also showed that in patients treated with thrombolytic agents, pre-stroke statin was associated with good functional outcome, despite an increased risk of symptomatic hemorrhagic transformation.

Recommendation

In patients with acute ischemic stroke or TIA and LDLC 100 mg/dL, it is indicated to prescribe statins (COR I, LOE A).

It is reasonable to continue statins after admission for acute ischemic stroke or TIA in patients who have already received statins before the stroke (COR IIa, LOE B).