Division of Neurology, Brain Research Centre, University of British Columbia, Stroke Program, Vancouver, British Columbia V5Z1M9, Canada.
Neurotherapeutics. 2011 Jul;8(3):475-87. doi: 10.1007/s13311-011-0060-2.
Stroke is one of the leading causes of disability and death. Ischemic stroke is a syndrome with heterogeneous mechanisms and multiple etiologies, rather than a singularly defined disease. Approximately one third of ischemic strokes are preceded by another cerebrovascular ischemic event. Stroke survivors are at high risk of vascular events (i.e., cerebrovascular and cardiovascular events), particularly during the first several months after the ischemic event. The use of antiplatelet agents remains the fundamental component of secondary stroke prevention. Based on the available data, antiplatelet agents should be used for patients with noncardioembolic stroke. The use of combination therapy (aspirin plus clopidogrel) has not been proven to be effective or safe to use for prevention of early stroke recurrence or in long-term treatment. There is no convincing evidence that any of the available antiplatelet agents are superior for a given stroke subtype. Currently, the uses of aspirin, clopidogrel, or aspirin combined with extended release dipyridamole are all valid alternatives after an ischemic stroke or transient ischemic attack. However, to maximize the effects of these agents, the treatment should be initiated as early as possible and be continued on a lifelong basis.
中风是导致残疾和死亡的主要原因之一。缺血性中风是一种具有异质性机制和多种病因的综合征，而不是一种单一定义的疾病。大约三分之一的缺血性中风之前有另一个脑血管缺血事件。中风幸存者发生血管事件（即脑血管和心血管事件）的风险很高，尤其是在缺血事件发生后的头几个月。抗血小板药物的使用仍然是二级预防中风的基本组成部分。根据现有数据，抗血小板药物应用于非心源性中风患者。联合治疗（阿司匹林加氯吡格雷）在预防早期中风复发或长期治疗方面的有效性和安全性尚未得到证实。没有令人信服的证据表明，任何现有的抗血小板药物在特定的中风亚型中都具有优势。目前，在缺血性中风或短暂性脑缺血发作后，阿司匹林、氯吡格雷或阿司匹林联合缓释双嘧达莫的使用都是有效的替代药物。然而，为了最大限度地发挥这些药物的作用，治疗应尽早开始，并持续终生。
