Leys Didier, Balucani Clotilde, Cordonnier Charlotte
Department of Neurology, Hôpital Roger Salengro, EA 2691, University Lille II, Lille, France.
Cerebrovasc Dis. 2009;27 Suppl 1:120-5. doi: 10.1159/000200449. Epub 2009 Apr 3.
In primary prevention trials conducted in low-risk subjects, aspirin is associated with a small reduction in ischemic strokes in women. It also reduces the incidence of stroke in patients with nonvalvular atrial fibrillation (NVAF), but warfarin is more effective in patients with high blood pressure, or left ventricular dysfunction, especially those aged >75 years. According to secondary prevention trials in patients after noncardioembolic ischemic stroke or transient ischemic attacks, aspirin at any dose between 50 and 1,300 mg per day reduces the risk of new events, but doses >150 mg per day are associated with a worse gastrointestinal tolerance. Clopidogrel and a combination of aspirin plus extended-release dipyridamole are both slightly more effective than aspirin, but the combination of aspirin and clopidogrel does not reduce the risk of new vascular events and increases life-threatening bleedings. Aspirin cannot be recommended for secondary prevention in NVAF, except in the case of absolute contraindications to warfarin. The available data show that at the acute stage of ischemic stroke, aspirin is safe and slightly more effective than placebo or heparin, even in NVAF, but other antiplatelet agents have not been evaluated.
在针对低风险受试者开展的一级预防试验中，阿司匹林可使女性缺血性卒中发生率略有降低。它还能降低非瓣膜性心房颤动（NVAF）患者的卒中发生率，但华法林对高血压或左心室功能不全患者，尤其是年龄大于75岁的患者更为有效。根据针对非心源性缺血性卒中或短暂性脑缺血发作后患者的二级预防试验，每天服用50至1300毫克之间的任何剂量阿司匹林均可降低新发病事件的风险，但每天剂量大于150毫克时胃肠道耐受性较差。氯吡格雷以及阿司匹林与缓释双嘧达莫的联合用药均比阿司匹林略有效，但阿司匹林与氯吡格雷联合用药并不能降低新的血管事件风险，反而会增加危及生命的出血风险。除了对华法林存在绝对禁忌的情况外，不推荐在NVAF二级预防中使用阿司匹林。现有数据表明，在缺血性卒中急性期，阿司匹林是安全的，甚至在NVAF患者中也比安慰剂或肝素略有效，但尚未对其他抗血小板药物进行评估。
