Booze Christopher D, Serebruany Victor L
Heart Drug Research Laboratories, Osler Medical Center, 7600 Osler Drive, Suite 307, Towson, MD 21204, USA.
Curr Treat Options Cardiovasc Med. 2006 May;8(3):221-7. doi: 10.1007/s11936-006-0015-9.
Aggrenox (Boehringer Ingelheim, Ingelheim, Germany), a novel combination of low-dose aspirin with dipyridamole, represents a safe and promising combination alternative for mild but sustained platelet inhibition, and reduction of both arterial and venous thrombi occurrences. In a large, well-controlled randomized trial (ESPS-2 ) evaluating antiplatelet agents for stroke prevention, Aggrenox was twice as effective as monotherapy with either aspirin or dipyridamole. There is an increasing body of evidence that a delicate strategy with Aggrenox provides modest inhibition of platelet activity, especially in a chronic, long-term setting. Mild platelet inhibition beyond conventional aggregation may represent a substantial advantage over aggressive antiplatelet regimens for the treatment, and especially for secondary prevention, of cerebrovascular ischemic events. Although there is no doubt that the concept of inhibiting platelets is vital for the treatment of vascular ischemic disease in general and ischemic stroke and transient ischemic attack (TIA) in particular, the optimal degree of such inhibition still remains an unsolved mystery. It seems that the concepts of "the more, the better" and "one size fits all" may no longer be valid for ideal antiplatelet protection in such high-risk populations. Without routine individual laboratory assessment of platelet function, mild regimens have the advantage of being more suitable for the majority of patients and will contribute substantially to the success of dipyridamole. Conversely, if we can determine baseline platelet status and intelligently apply therapy based on platelet activity in each particular patient, clinical outcomes may be better. Avoiding excessive bleeding risks after aggressive strategies in patients with normal or already decreased platelet function, but targeting those who exhibit activated platelets, may improve risk stratification and save lives. Therefore, Aggrenox should be considered a drug of choice to prevent the second stroke. Eliminating, or at least minimizing, the most frequent side effect, namely transitory headaches at the beginning of therapy with Aggrenox, will benefit patients and increase the use of this agent. Should the PRoFESS (Prevention Regimen For Effectively avoiding Second Strokes) trial show an advantage in event reduction with Aggrenox over clopidogrel, the increase will be especially dramatic. In short, based on current evidence most guidelines include Aggrenox as a first-line option for secondary prevention of ischemic stroke or TIA, and some recent versions suggest it may be preferable in other clinical scenarios.
阿格雷诺克斯（德国英格海姆勃林格殷格翰公司生产）是低剂量阿司匹林与双嘧达莫的新型组合，是一种安全且有前景的联合用药方案，可实现轻度但持续的血小板抑制，并减少动脉和静脉血栓的发生。在一项评估抗血小板药物预防中风的大型、严格对照随机试验（ESPS - 2）中，阿格雷诺克斯的效果是单独使用阿司匹林或双嘧达莫单一疗法的两倍。越来越多的证据表明，使用阿格雷诺克斯的精细策略可适度抑制血小板活性，尤其是在慢性、长期情况下。对于脑血管缺血事件的治疗，特别是二级预防，除传统聚集作用外的轻度血小板抑制可能比积极的抗血小板方案具有显著优势。虽然毫无疑问，抑制血小板的理念对于一般血管缺血性疾病，特别是缺血性中风和短暂性脑缺血发作（TIA）的治疗至关重要，但这种抑制的最佳程度仍然是一个未解之谜。在这类高危人群中，“越多越好”和“一刀切”的理念似乎已不再适用于理想的抗血小板保护。在没有常规的血小板功能个体实验室评估的情况下，轻度治疗方案的优势在于更适合大多数患者，并将极大地有助于双嘧达莫治疗的成功。相反，如果我们能够确定基线血小板状态，并根据每个特定患者血小板活性智能地应用治疗，临床结果可能会更好。对于血小板功能正常或已经降低的患者，避免积极治疗策略后出现过度出血风险，但针对那些血小板活化的患者，可能会改善风险分层并挽救生命。因此，阿格雷诺克斯应被视为预防二次中风的首选药物。消除或至少最小化最常见的副作用，即在使用阿格雷诺克斯治疗开始时出现的短暂性头痛，将使患者受益并增加该药物的使用。如果PRoFESS（有效避免二次中风预防方案）试验表明阿格雷诺克斯在减少事件发生方面优于氯吡格雷，这种增加将尤为显著。简而言之，根据目前的证据，大多数指南将阿格雷诺克斯列为缺血性中风或TIA二级预防的一线选择，一些最新版本表明在其他临床情况下它可能更具优势。
