Hankey Graeme J
Consultant Neurologist and Head of Stroke Unit, Department of Neurology, Royal Perth Hospital, 197 Wellington Street, Perth, Western Australia 6001, Australia.
Curr Atheroscler Rep. 2007 Oct;9(4):312-8. doi: 10.1007/s11883-007-0038-z.
Recent trials of antiplatelet therapy for stroke prevention indicate that the combination of clopidogrel (75 mg/d) plus low-dose aspirin (75-162 mg/d) was not more effective than low-dose aspirin alone in the long-term prevention of major vascular events among patients at high risk of atherothrombotic events, nor was it more effective than oral anticoagulation in patients with atrial fibrillation. Furthermore, oral anticoagulation (International Normalized Ratio of 2.0-3.0) was not more effective than aspirin alone among patients with recent cerebral ischemia of presumed arterial origin. However, the addition of extended-release dipyridamole to aspirin was more effective than aspirin alone among patients with recent cerebral ischemia of presumed arterial origin. A large trial comparing clopidogrel with the combination of aspirin and extended-release dipyridamole in more than 20,000 patients with recent (< 120 days) atherothrombotic ischemic stroke is expected to report in 2008.
近期用于预防中风的抗血小板治疗试验表明，对于有动脉粥样硬化血栓形成事件高风险的患者，氯吡格雷（75毫克/天）加小剂量阿司匹林（75 - 162毫克/天）联合用药在长期预防主要血管事件方面并不比单独使用小剂量阿司匹林更有效，对于房颤患者也不比口服抗凝药更有效。此外，对于近期有推测为动脉源性脑缺血的患者，口服抗凝治疗（国际标准化比值为2.0 - 3.0）并不比单独使用阿司匹林更有效。然而，在近期有推测为动脉源性脑缺血的患者中，阿司匹林加缓释双嘧达莫比单独使用阿司匹林更有效。一项在20000多名近期（<120天）发生动脉粥样硬化血栓形成性缺血性中风的患者中比较氯吡格雷与阿司匹林和缓释双嘧达莫联合用药的大型试验预计将于2008年公布结果。
