Department of Neurology, Royal Perth Hospital, Australia.
Lancet Neurol. 2010 Mar;9(3):273-84. doi: 10.1016/S1474-4422(10)70038-7.
Aspirin is widely used for the prevention of recurrent stroke in patients with transient ischaemic attack (TIA) and ischaemic stroke of arterial origin, because it is effective and inexpensive. Clopidogrel and the combination of aspirin and extended-release dipyridamole are more effective than aspirin, but are also much more expensive. No other antithrombotic regimens provide significant advantages over aspirin, although cilostazol and the novel platelet protease activated receptor-1 antagonist, SCH 530348, are currently being evaluated. For patients with TIA and ischaemic stroke of cardiac origin due to atrial fibrillation, vitamin K antagonists (VKAs) are highly effective in preventing recurrent ischaemic stroke but have important limitations and are thus underused. Antiplatelet therapy is much less effective than VKAs. The direct thrombin inhibitor, dabigatran etexilate, has shown efficacy over warfarin in a recent trial. Other new anticoagulants, including the oral factor Xa inhibitors, rivaroxaban, apixaban, and edoxaban, the parenteral factor Xa inhibitor, idrabiotaparinux, and the novel VKA, tecarfarin, are currently being assessed.
阿司匹林被广泛用于预防短暂性脑缺血发作（TIA）和动脉来源的缺血性卒中患者的复发，因为它既有效又廉价。氯吡格雷和阿司匹林与延长释放双嘧达莫的联合用药比阿司匹林更有效，但也更昂贵。没有其他抗血栓形成方案比阿司匹林提供显著优势，尽管西洛他唑和新型血小板蛋白酶激活受体-1拮抗剂 SCH530348 目前正在评估中。对于由于心房颤动引起的 TIA 和源于心脏的缺血性卒中患者，维生素 K 拮抗剂（VKA）在预防复发性缺血性卒中方面非常有效，但存在重要限制，因此使用不足。抗血小板治疗比 VKA 有效得多。直接凝血酶抑制剂达比加群酯在最近的一项试验中已显示出优于华法林的疗效。其他新型抗凝剂，包括口服 Xa 因子抑制剂利伐沙班、阿哌沙班和依度沙班、皮下 Xa 因子抑制剂依达肝素钠和新型 VKA 替卡格雷林，目前正在评估中。
