Zuurbier S M Yvonne, Vermeer Sarah E, Hilkens Pieter H E, Algra Ale, Roos Yvo B W E M
Academisch Medisch Centrum, afd. Neurologie, Amsterdam, the Netherlands.
Ned Tijdschr Geneeskd. 2013;157(25):A5836.
In patients with TIA or stroke of arterial origin various antiplatelet agents, or combinations of these, have been found to be effective to reduce the risk of new vascular complications. International guidelines currently recommend three treatment strategies with antiplatelet agents after TIA or stroke: acetylsalicylic acid in combination with dipyridamole, clopidogrel monotherapy, or alternatively acetylsalicylic acid monotherapy. In the Netherlands, current standard antiplatelet therapy after a TIA or stroke is a combination of acetylsalicylic acid and dipyridamole. Clopidogrel monotherapy is probably equally as effective as the combination of acetylsalicylic acid and dipyridamole. Clopidogrel monotherapy is easier to use, has fewer side effects and has recently become cheaper than the combination of acetylsalicylic acid and dipyridamole. For secondary prevention in the Netherlands we advise following the international guidelines on thromboprophylaxis after TIA or stroke. Clopidogrel could be considered as an alternative treatment to the combination of acetylsalicylic acid and dipyridamole.
在动脉源性短暂性脑缺血发作（TIA）或中风患者中，已发现各种抗血小板药物或其组合可有效降低新的血管并发症风险。目前国际指南推荐TIA或中风后使用抗血小板药物的三种治疗策略：阿司匹林联合双嘧达莫、氯吡格雷单药治疗，或阿司匹林单药治疗。在荷兰，目前TIA或中风后的标准抗血小板治疗是阿司匹林和双嘧达莫联合使用。氯吡格雷单药治疗可能与阿司匹林和双嘧达莫联合治疗同样有效。氯吡格雷单药治疗使用更方便，副作用更少，且最近已变得比阿司匹林和双嘧达莫联合治疗更便宜。对于荷兰的二级预防，我们建议遵循国际上关于TIA或中风后血栓预防的指南。氯吡格雷可被视为阿司匹林和双嘧达莫联合治疗的替代疗法。
