关键词: 卒中, 脑缺血, 阿司匹林, 氯吡格雷, 患者再入院

Abstract:

Objective：To see the influence of different antiplatelet therapies on stroke patients’ readmission by performing a deep data-mining into Beijing Healthcare Insuring Database, based on a large sample size. Methods: Aretrospective cohort study, was adopted to extract patients primarily diagnosed as ischemic stroke from healthcare database. The first hospital records were considered as the patient’s baseline in this study, who were divided into MAPT (aspirin) and DAPT (aspirin and clopidogrel) according to the patient’s baseline medications. A follow-up was conducted to see whether the patients would have rehospitalization record because of major result events after medication. The major result events, included: (1) recurrence of ischemic stroke; (2) hemorrhagic transformation of ischemic stroke; (3) myocardial infarction; (4) the digestive hemorrhage. The Kaplan-Meier figure was used to compare the survival situations between these two groups, the log-rank test was used to test the difference of the survival curve, and 1 ∶1 propensity score matching was calculated from the patients’ baseline data. Cox proportional hazards model was used to calculate the hazard ratio (HR).  Results: A total of 27 695 patients From January 2010 to September 2013 were included, 4 047 with DAPT, and 23 648 with MAPT. Because the baseline characteristics of the patients was disequilibrium, so we used 1 ∶1 propensity score matching, after which, the number of the two groups was 4 046 each. Adjusted for the general demographic characteristics such as age, sex, nationality, complication and drug combination, no statistical significance was observed between the survival curves of the two groups (P=0.06). HR value of major result events between the groups was 0.91 (0.82-1.01, P=0.07), which was not statistically significant. The covariate gender HR=1.36 (1.20-1.55, P<0.05), accompanied by diabetes HR= 1.36 (1.20-1.54, P<0.05), dyslipidemia HR=1.13 (1.00-1.27, P=1.13), heart disease HR=1.39 (1.22-1.58, P<0.05) was statistically significant. Drug combination with other antiplatelet agents HR=1.05 (0.95-1.17, P>1.05) did not increase the risk of readmission. Conclusion: There was no difference in prevention of readmission between patients with DAPT and MAPT. Patients with complications should actively treat the complications at the same time as they prevent recurrence after first attack.

Key words: Stroke, Brain ischemia, Aspirin, Clopidogrel, Patient readmission