氯吡格雷停药后伴有先兆偏头痛:炎症是偏头痛诱因的证据?-个案报告

C. Folchini, Paulo Sergio Faro Santos, Jessica Giraldes, Amanda Batista Machado, P. Kowacs
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引用次数: 0

摘要

本文报道了一位接受双重抗血小板治疗的PFO(卵圆孔未闭)闭合性患者,该患者在停用氯吡格雷之前停用阿司匹林,在停用氯吡格雷后出现“从头”偏头痛并伴有视觉先兆发作。先兆偏头痛与心房右至左分流(PFO和其他房间隔缺陷)相关,是由于血管活性物质到达大脑,而不是被肺部清除。在本例中,PFO关闭一年后停用氯吡格雷引起先兆偏头痛的“新生”。结论氯吡格雷对先兆偏头痛的预防作用尚未得到证实,其在氯吡格雷停药时的触发更可能与停用氯吡格雷的促炎作用有关。在心脏病学研究中已经描述了这种促炎作用,并强调接受双重抗血小板治疗(氯吡格雷和阿司匹林)的患者应该在阿司匹林之前停用氯吡格雷,以避免促炎或促血栓事件。
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Migraine with aura after clopidogrel withdrawal: evidence of inflammation as a migraine trigger? – Case report
This article presents the case of a PFO (patent foramen ovale) closure patient with double antiplatelet therapy in whom aspirin was discontinued before clopidogrel and that, at clopidogrel withdrawal, presented “de novo” migraine with visual aura attacks. Migraines with aura associated with atrial right-to-left shunts (PFO and other atrial septal defects) are attributed to the arrival of vasoactive substances in the brain, since not cleared by the lungs. In this case, discontinuation of clopidogrel one year after PFO closure induced “de novo” migraine with aura. Conclusion Rather than confirming the prophylactic effects of clopidogrel for migraine with aura, its triggering at clopidogrel withdrawal is more likely related to a proinflammatory effect of discontinuing clopidogrel. This proinflammatory effect has been described in cardiological research, and reinforces that patients receiving dual antiplatelet therapy (clopidogrel and aspirin) should always have clopidogrel discontinued before aspirin in order to avoid proinflammatory or pro-thrombotic events.
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