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학제간연구 과학기술학 뇌인지과학 기술정책 기타 복합학

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논문 기본 정보

자료유형
학술저널
저자정보
저널정보
한국병원약사회 병원약사회지 병원약사회지 제35권 제2호
발행연도
2018.1
수록면
184 - 195 (12page)

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Background : Generally speaking, the condition of dyslipidemia is a major risk factor for the development of an ischemic stroke. The domestic and international stroke guidelines recommend that physicians follow the 2004 NCEP-ATP III and 2013 ACC/AHA dyslipidemia treatment guidelines when using statins for the prevention of an ischemic stroke. However, the role of statin therapy in the patients with acute cerebral infarction has not been established, and is generally prescribed under clinical judgment. The purpose of this study was to evaluate the status and appropriateness of the statin treatment for patients with an acute cerebral infarction in the emergency department. Methods : In this study, we analyzed 430 patients who were diagnosed with an ischemic stroke at the Seoul National University Hospital from July 2013 to May 2015. We retrospectively analyzed the prescription pattern of statin therapy for the first 72 hours and 3 months, after the admission due to an ischemic stroke with a review of the patient electronic medical records. We also evaluated the effects of statin use during an acute phase of ischemic stroke on the patient clinical outcomes. Results : Among the 430 patients who participated in the study, there were 314 patients (73.0%) who received a statin within 72 hours after admission, and 246 patients (78.3%) who were prescribed with moderate intensity statins. The predictors of statin therapy within 72 hours after hospital admission were patients who had received previous statin use (aOR 7.38, 95% CI 3.77-14.44), LDL 100 mg/dL on admission (aOR 8.98, 95% CI 4.99-16.19), and who had experienced large artery atherosclerosis (aOR 2.92, 95% CI 1.64-5.22) type by TOAST classification. In addition, the high-intensity statin was less prescribed in a stroke of cardioembolism (aOR 0.33, 95% CI 0.12-0.90), and a small vessel occlusion (aOR 0.28, 95% CI 0.11-0.70), as compared with a large artery atherosclerosis. The compliance with the 2013 ACC/AHA guideline on the treatment of hyperlipidemia was 34.1% in this case. The use of statin within 72 hours after admission did not affect each clinical outcome, which included early neurological deterioration for 7 days, mRS 2 at 3 months and a recurrent ischemic stroke within 3 months after admission. Conclusion : The main factors influencing the prescription status and clinical outcome were a previous medication, LDL level, and the pathogenesis of a stroke. The effect of the statin on the clinical outcome in an acute cerebral infarction should be confirmed by a prospective study of stroke patients with the same pathogenesis.

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참고문헌 신청
박태환 / 2008 / 한국인에서 허혈성 뇌졸중에 대한 주요 위험인자들의 인구기여위험도 / 대한뇌졸중학회지 10(2):125~133 dbpia Keun-Sik Hong / 2013 / Stroke Statistics in Korea: Part I. Epidemiology and Risk Factors: A Report from the Korean Stroke Society and Clinical Research Center for Stroke / 대한뇌졸중학회지 15(1):2~20 dbpia Investigators SPbARiCL / 2006 / High-dose atorvastatin after stroke or transient ischemic attack / N engl J med 2006(355):549~559 google schola Amarenco P / 2003 / Statins and stroke prevention / Cerebrovascular Diseases 17(Suppl. 1):81~88 google schola Vaughan CJ / 1999 / Neuroprotective properties of statins in cerebral ischemia and stroke / Stroke 30(9):1969~1973 Crossref

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