Ann Intern Med. 2013 Oct 1;159(7):463-70. doi: 10.7326/0003-4819-159-7-201310010-00006.
Dual-antiplatelet regimens for prevention of recurrent stroke promote antithrombotic effects but may increase the risk for hemorrhage.
To qualitatively and quantitatively examine the risk for recurrent stroke and intracranial hemorrhage (ICH) linked to long-term dual- and single-antiplatelet therapy among patients with ischemic stroke and transient ischemic attack.
PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials through March 2013 without language restrictions.
The search identified 7 randomized, controlled trials that involved a total of 39,574 participants and reported recurrent stroke and ICH as outcome measures.
All data from eligible studies were independently abstracted by 2 investigators according to a standard protocol.
Recurrent stroke risk did not differ between patients receiving dual-antiplatelet therapy and those receiving aspirin monotherapy (relative risk [RR], 0.89 [95% CI, 0.78 to 1.01]) or clopidogrel monotherapy (RR, 1.01 [CI, 0.93 to 1.08]). Risk for ICH did not differ between patients receiving dual-antiplatelet therapy and those receiving aspirin monotherapy (RR, 0.99 [CI, 0.70 to 1.42]) but was greater among patients receiving dual-antiplatelet therapy than among those receiving clopidogrel monotherapy (RR, 1.46 [CI, 1.17 to 1.82]).
Agents used in dual- and single-antiplatelet therapies varied across trials, and the relatively modest number of trials limited subgroup analysis.
Compared with monotherapy, dual-antiplatelet therapy lasting more than 1 year after an index ischemic stroke or transient ischemic attack is not associated with a greater reduction in overall recurrent stroke risk. However, long-term dual-antiplatelet therapy is linked to higher risk for ICH than clopidogrel monotherapy in this patient population.
Chang Gung Memorial Hospital.
预防复发性中风的双联抗血小板治疗方案可增强抗血栓作用，但可能会增加出血风险。
定性和定量研究缺血性卒中和短暂性脑缺血发作患者长期双联和单联抗血小板治疗与复发性中风和颅内出血（ICH）风险的相关性。
通过无语言限制的检索，从 PubMed、EMBASE 和 Cochrane 中心对照试验注册库获取 2013 年 3 月之前的数据。
该检索共纳入 7 项随机对照试验，总计 39574 名参与者，以复发性中风和 ICH 为结局指标。
两名研究者按照标准方案独立提取所有合格研究的数据。
双联抗血小板治疗组患者的复发性中风风险与阿司匹林单药治疗组（相对风险 [RR]，0.89 [95% CI，0.78 至 1.01]）或氯吡格雷单药治疗组（RR，1.01 [CI，0.93 至 1.08]）之间无差异。双联抗血小板治疗组患者的 ICH 风险与阿司匹林单药治疗组（RR，0.99 [CI，0.70 至 1.42]）之间无差异，但与氯吡格雷单药治疗组（RR，1.46 [CI，1.17 至 1.82]）之间存在差异。
各试验中双联和单联抗血小板治疗所使用的药物不同，且试验数量相对较少限制了亚组分析。
与单药治疗相比，在索引性缺血性卒中和短暂性脑缺血发作后 1 年以上进行的双联抗血小板治疗并不能降低总体复发性中风风险。然而，与氯吡格雷单药治疗相比，长期双联抗血小板治疗与该患者人群的 ICH 风险增加相关。
长庚纪念医院。
