Taylor D W, Barnett H J, Haynes R B, Ferguson G G, Sackett D L, Thorpe K E, Simard D, Silver F L, Hachinski V, Clagett G P, Barnes R, Spence J D
Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
Lancet. 1999 Jun 26;353(9171):2179-84. doi: 10.1016/s0140-6736(99)05388-x.
Endarterectomy benefits certain patients with carotid stenosis, but benefits are lessened by perioperative surgical risk. Acetylsalicylic acid lowers the risk of stroke in patients who have experienced transient ischaemic attack and stroke. We investigated appropriate doses and the role of acetylsalicylic acid in patients undergoing carotid endarterectomy.
In a randomised, double-blind, controlled trial, 2849 patients scheduled for endarterectomy were randomly assigned 81 mg (n=709), 325 mg (n=708), 650 mg (n=715), or 1300 mg (n=717) acetylsalicylic acid daily, started before surgery and continued for 3 months. We recorded occurrences of stroke, myocardial infarction, and death. We compared patients on the two higher doses of acetylsalicylic acid with patients on the two lower doses.
Surgery was cancelled in 45 patients, none were lost to follow-up by 30 days, and two were lost by 3 months. The combined rate of stroke, myocardial infarction, and death was lower in the low-dose groups than in the high-dose groups at 30 days (5.4 vs 7.0%, p=0.07) and at 3 months (6.2 vs 8.4%, p=0.03). In an efficacy analysis, which excluded patients taking 650 mg or more acetylsalicylic acid before randomisation, and patients randomised within 1 day of surgery, combined rates were 3.7% and 8.2%, respectively, at 30 days (p=0.002) and 4.2% and 10.0% at 3 months (p=0.0002).
The risk of stroke, myocardial infarction, and death within 30 days and 3 months of endarterectomy is lower for patients taking 81 mg or 325 mg acetylsalicylic acid daily than for those taking 650 mg or 1300 mg.
动脉内膜切除术对某些颈动脉狭窄患者有益,但围手术期手术风险会降低其益处。阿司匹林可降低经历过短暂性脑缺血发作和中风的患者的中风风险。我们研究了阿司匹林在接受颈动脉内膜切除术患者中的合适剂量及其作用。
在一项随机、双盲、对照试验中,2849例计划接受内膜切除术的患者被随机分配,每日服用81毫克(n = 709)、325毫克(n = 708)、650毫克(n = 715)或1300毫克(n = 717)阿司匹林,术前开始服用并持续3个月。我们记录了中风、心肌梗死和死亡的发生情况。我们将服用两种较高剂量阿司匹林的患者与服用两种较低剂量阿司匹林的患者进行了比较。
45例患者手术取消,30天内无失访患者,3个月时有2例失访。低剂量组在30天时(5.4% 对7.0%,p = 0.07)和3个月时(6.2% 对8.4%,p = 0.03)中风、心肌梗死和死亡的综合发生率低于高剂量组。在一项疗效分析中,排除随机分组前服用650毫克或更多阿司匹林的患者以及在手术1天内随机分组的患者,30天时综合发生率分别为3.7%和8.2%(p = 0.002),3个月时分别为4.2%和10.0%(p = 0.0002)。
对于每日服用81毫克或325毫克阿司匹林的患者,颈动脉内膜切除术后30天和3个月内中风、心肌梗死和死亡的风险低于服用650毫克或1300毫克的患者。