ESUS治療之過去、現在及未來

Treatment for ESUS: Past, Present, and Future

蔡力凱(Li-Kai Tsai)

《台灣中風醫誌》 1卷1期 (2019/06) Pp. 31-37

https://doi.org/10.6318/FJS.201906_1(1).0003

並列摘要

Previous clinical trials have demonstrated that warfarin was not better than antiplatelet agents for secondary stroke prevention in patients with non-cardiogenic ischemic stroke, including embolic stroke of undetermined source (ESUS). However, anticoagulants may be effective for stroke prevention in some major causes of ESUS such as paroxysmal atrial fibrillation (AF), minor-risk cardioembolic source, paradoxical embolism, and cancer-related stroke. Notably, paroxysmal AF was detected in about 30% patients with cryptogenic stroke or ESUS using a long-term cardiac recorder. Therefore, two recent large clinical trials compared the effectiveness and safety of non-vitamin K antagonist oral anticoagulants than aspirin for patients with ESUS. The NAVIGATE trial showed that rivaroxaban had similar effect in stroke prevention but higher risk of major bleeding in comparison with aspirin. The RE-SPECT ESUS trial demonstrated that dabigatran and aspirin had similar risk in stroke and major bleeding. With the essentially negative results of both trials, the concept of ESUS might be modified to be ESPS (embolic stroke of possible source) in the future. Various devices for cardiac monitoring may be helpful to increase the AF detection rate. The results of ongoing trials comparing apixaban and aspirin in patients with both ESUS and atrial cardiopathy are anticipated.

並列關鍵字

Anticoagulants ； antiplatelets ； embolism ； ESUS ； Stroke