Field Thalia S, Nakajima Makoto, Benavente Oscar R
Division of Neurology, (Department of Medicine), Vancouver Stroke Program, Brain Research Center, University of British Columbia, S169-2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada,
Curr Treat Options Cardiovasc Med. 2013 Jun;15(3):348-59. doi: 10.1007/s11936-013-0241-x.
Though antiplatelet agents are the mainstay of antithrombotic therapy for secondary prevention of noncardioembolic cerebral ischemic events, the efficacy of combination aspirin and clopidogrel has yet to be clarified by clinical trials. Current evidence suggests that there is no role for long-term combination of aspirin/clopidogrel for secondary stroke prevention. Recent preliminary data from the CHANCE (Clopidogrel in High-risk Patients with Acute Non-disabling Cerebrovascular Events) trial suggests that stroke recurrence at 90 days is reduced by a short course (21 days) of combination aspirin/clopidogrel initiated within 24 hours of minor stroke or TIA (Transient Ischemic Attack) compared with aspirin alone [1••] (Table 1). Other ongoing trials, which are also investigating the role of short-term combination antiplatelet therapy initiated immediately after minor stroke and TIA, will determine if these findings will be replicated.
尽管抗血小板药物是预防非心源性脑缺血事件继发血栓形成的主要抗栓治疗药物，但阿司匹林和氯吡格雷联合使用的疗效尚未得到临床试验的证实。目前的证据表明，阿司匹林/氯吡格雷长期联合用药对预防卒中复发并无作用。近期来自CHANCE（急性非致残性脑血管事件高危患者的氯吡格雷）试验的初步数据表明，与单用阿司匹林相比，在轻度卒中或短暂性脑缺血发作（TIA）24小时内开始短期（21天）联合使用阿司匹林/氯吡格雷可降低90天时的卒中复发率[1••]（表1）。其他正在进行的试验也在研究轻度卒中和TIA后立即开始短期联合抗血小板治疗的作用，这些试验将确定这些发现是否会得到重复。
