Trong \u1ea5n b\u1ea3n NEJM Journal Watch (General Meidicne) Year in Review 2018, Editor Allan S. Brett, MD. \u0111\u00e3 t\u1ed5ng h\u1ee3p k\u1ebft qu\u1ea3 nghi\u00ean c\u1ee9u nh\u1eefng nghi\u00ean c\u1ee9u n\u1ed5i b\u1eadt trong n\u0103m 2018 v\u1ec1 v\u1ec1 ph\u01b0\u01a1ng ph\u00e1p kh\u00e1ng ti\u1ec3u c\u1ea7u k\u00e9p v\u00e0 can thi\u1ec7p n\u1ed9i m\u1ea1ch lo\u1ea1i b\u1ecf huy\u1ebft kh\u1ed1i giai \u0111o\u1ea1n mu\u1ed9n.<\/p>\n
N\u0103m 2018, nh\u1eefng nghi\u00ean c\u1ee9u quan tr\u1ecdng v\u1ec1 \u0111\u1ed9t qu\u1ef5<\/strong> bao tr\u00f9m c\u00e1c ch\u1ee7 \u0111\u1ec1 t\u1eeb c\u01a1n thi\u1ebfu m\u00e3u n\u00e3o tho\u00e1ng qua (TIA) cho t\u1edbi \u0111\u1ed9t qu\u1ef5 g\u00e2y t\u00e0n t\u1eadt nghi\u00eam tr\u1ecdng.<\/p>\n Trong th\u1eed nghi\u1ec7m ph\u00e2n nh\u00f3m ng\u1eabu nhi\u00ean POINT, c\u00e1c nh\u00e0 nghi\u00ean c\u1ee9u \u0111\u00e3 ki\u1ec3m ch\u1ee9ng gi\u1ea3 thuy\u1ebft li\u1ec7u \u0111i\u1ec1u tr\u1ecb kh\u00e1ng ti\u1ec3u c\u1ea7u k\u00e9p (DAPT) s\u1edbm c\u00f3 c\u1ea3i thi\u1ec7n \u0111\u01b0\u1ee3c c\u00e1c k\u1ebft qu\u1ea3 \u1edf b\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 TIA cao, \u0111\u1ed9t qu\u1ef5 do thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9 kh\u00f4ng do rung t\u00e2m nh\u0129 ho\u1eb7c h\u1eb9p \u0111\u1ed9ng m\u1ea1ch c\u1ea3nh (c\u1ea7n c\u00e1c can thi\u1ec7p kh\u00e1c) hay kh\u00f4ng. G\u1ea7n 5000 b\u1ec7nh nh\u00e2n \u0111\u00e3 \u0111i\u1ec1u tr\u1ecb h\u00e0ng ng\u00e0y v\u1edbi aspirin li\u1ec1u th\u1ea5p \u0111\u01a1n \u0111\u1ed9c ho\u1eb7c aspirin li\u1ec1u th\u1ea5p k\u1ebft h\u1ee3p clopidogrel (li\u1ec1u n\u1ea1p 600 mg, li\u1ec1u duy tr\u00ec 75 mg\/ ng\u00e0y), b\u1eaft \u0111\u1ea7u trong v\u00f2ng 12 ti\u1ebfng k\u1ec3 t\u1eeb khi tri\u1ec7u ch\u1ee9ng kh\u1edfi ph\u00e1t. Trong 90 ng\u00e0y, nh\u00f3m \u0111i\u1ec1u tr\u1ecb DAPT c\u00f3 t\u1ec9 l\u1ec7 \u0111\u1ed9t qu\u1ef5 t\u00e1i ph\u00e1t do nh\u1ed3i m\u00e1u n\u00e3o th\u1ea5p h\u01a1n \u0111\u00e1ng k\u1ec3 (4,6% so v\u1edbi 6,3%) nh\u01b0ng l\u1ea1i c\u00f3 t\u1ec9 l\u1ec7 xu\u1ea5t huy\u1ebft cao h\u01a1n (0,9% so v\u1edbi 0,4%). Tuy nhi\u00ean, vi\u1ec7c gi\u1ea3m \u0111\u1ed9t qu\u1ef5 t\u00e1i ph\u00e1t g\u1ea7n nh\u01b0 x\u1ea3y ra ho\u00e0n to\u00e0n trong tu\u1ea7n \u0111\u1ea7u ti\u00ean, trong khi xu\u1ea5t huy\u1ebft (h\u1ea7u h\u1ebft kh\u00f4ng ph\u1ea3i xu\u1ea5t huy\u1ebft n\u00e3o) xu\u1ea5t hi\u1ec7n kh\u00e1 \u0111\u1ec1u \u0111\u1eb7n trong su\u1ed1t 90 ng\u00e0y theo d\u00f5i. Do \u0111\u00f3, c\u00f3 th\u1ec3 t\u1ed1i \u0111a l\u1ee3i \u00edch v\u00e0 gi\u1ea3m thi\u1ec3u nguy c\u01a1 b\u1eb1ng c\u00e1ch ch\u1ec9 n\u00ean s\u1eed d\u1ee5ng DAPT trong v\u00e0i tu\u1ea7n \u0111\u1ea7u (NEJM JW Gen Med ng\u00e0y 1\/7 v\u00e0 N Engl J Med ng\u00e0y 19\/7; 379:215).<\/p>\n Trong 2 nghi\u00ean c\u1ee9u kh\u00e1c, c\u00e1c nh\u00e0 nghi\u00ean c\u1ee9u mu\u1ed1n ki\u1ec3m ch\u1ee9ng li\u1ec7u c\u00f3 th\u1ec3 k\u00e9o d\u00e0i c\u1eeda s\u1ed5 th\u1eddi \u0111i\u1ec3m \u0111i\u1ec1u tr\u1ecb lo\u1ea1i b\u1ecf huy\u1ebft kh\u1ed1i n\u1ed9i m\u1ea1ch \u0111\u1ebfn sau 6 ti\u1ebfng \u1edf b\u1ec7nh nh\u00e2n nh\u1ed3i m\u00e1u n\u00e3o trung b\u00ecnh \u0111\u1ebfn n\u1eb7ng do t\u1eafc \u0111\u1ed9ng m\u1ea1ch c\u1ea3nh trong ho\u1eb7c t\u1eafc \u0111\u1ed9ng m\u1ea1ch n\u00e3o gi\u1eefa hay kh\u00f4ng. \u0110\u1ed1i t\u01b0\u1ee3ng nghi\u00ean c\u1ee9u l\u00e0 nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 h\u00ecnh \u1ea3nh th\u1ec3 t\u00edch nh\u1ed3i m\u00e1u nh\u1ecf h\u01a1n d\u1ef1 \u0111o\u00e1n t\u1eeb b\u1ec7nh c\u1ea3nh l\u00e2m s\u00e0ng \u2013 cho th\u1ea5y m\u1ed9t v\u00f9ng c\u1ee7a n\u00e3o b\u1ecb gi\u1ea3m t\u01b0\u1edbi m\u00e1u ch\u1ee9 ch\u01b0a nh\u1ed3i m\u00e1u. Trong th\u1eed nghi\u1ec7m DAWN, 206 b\u1ec7nh nh\u00e2n kh\u1ecfe m\u1ea1nh trong v\u00f2ng 6 \u0111\u1ebfn 24 gi\u1edd tr\u01b0\u1edbc \u0111\u01b0\u1ee3c ph\u00e2n nh\u00f3m ng\u1eabu nhi\u00ean \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb lo\u1ea1i b\u1ecf huy\u1ebft kh\u1ed1i k\u1ebft h\u1ee3p ch\u0103m s\u00f3c ti\u00eau chu\u1ea9n ho\u1eb7c ch\u1ec9 ch\u0103m s\u00f3c ti\u00eau chu\u1ea9n.<\/p>\n B\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c lo\u1ea1i b\u1ecf huy\u1ebft kh\u1ed1i ph\u1ee5c h\u1ed3i \u0111\u1ed9c l\u1eadp ch\u1ee9c n\u0103ng nhi\u1ec1u h\u01a1n r\u00f5 r\u1ec7t so v\u1edbi nh\u00f3m ch\u0103m s\u00f3c ti\u00eau chu\u1ea9n trong th\u1eddi gian 90 ng\u00e0y (49% so v\u1edbi 13%; NEJM JW Neurol th\u00e1ng 1 v\u00e0 N Engl J Med ng\u00e0y 4\/1; 378:11).<\/p>\n Trong m\u1ed9t th\u1eed nghi\u1ec7m t\u01b0\u01a1ng t\u1ef1 tr\u00ean 182 b\u1ec7nh nh\u00e2n (th\u1eed nghi\u1ec7m DEFUSE 3), c\u00e1c k\u1ebft qu\u1ea3 v\u1ec1 \u0111\u1ed9c l\u1eadp ch\u1ee9c n\u0103ng t\u01b0\u01a1ng t\u1ef1 nh\u01b0 th\u1eed nghi\u1ec7m DAWN, th\u00eam v\u00e0o \u0111\u00f3, t\u1ec9 l\u1ec7 t\u1eed vong c\u0169ng th\u1ea5p h\u01a1n \u1edf nh\u00f3m lo\u1ea1i b\u1ecf huy\u1ebft kh\u1ed1i (14% so v\u1edbi 26%; P=0,05; NEJM JW Gen Med ng\u00e0y 15\/3 v\u00e0 N Engl J Med ng\u00e0y 22\/2; 378:708).<\/p>\n Nh\u1eefng nghi\u00ean c\u1ee9u tr\u00ean cho th\u1ea5y lo\u1ea1i b\u1ecf huy\u1ebft kh\u1ed1i mu\u1ed9n v\u1eabn c\u00f3 th\u1ec3 \u0111em l\u1ea1i l\u1ee3i \u00edch tr\u00ean nh\u00f3m b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c l\u1ef1a ch\u1ecdn c\u1ea9n th\u1eadn, m\u1eb7c d\u00f9 n\u00ean \u0111i\u1ec1u tr\u1ecb s\u1edbm khi c\u00f3 th\u1ec3.<\/p>\n