Yi Xingyang, Lin Jing, Wang Chun, Zhang Biao, Chi Wanzhang
Department of Neurology, People's Hospital of Deyang City, Deyang, Sichuan.
Department of Neurology, Third Affiliated Hospital of Wenzhou Medical College, Wenzhou, Zhejiang, China.
J Stroke Cerebrovasc Dis. 2014 Aug;23(7):1975-81. doi: 10.1016/j.jstrokecerebrovasdis.2014.01.022. Epub 2014 Apr 13.
Antiplatelet drugs are recommended for patients with acute noncardioembolic stroke. However, few randomized clinical trials have investigated the safety and efficacy of dual antiplatelet therapy for these patients. The aim of this study was to evaluate the effects of treatment with clopidogrel and aspirin (combination therapy) and aspirin alone (monotherapy) on neurologic deterioration, platelet activation, and other short-term outcomes in patients with acute large-artery atherosclerosis stroke.
Altogether 574 patients with acute (≤2 days) large-artery atherosclerosis stroke were randomly assigned to receive either combined clopidogrel and aspirin or aspirin alone. Platelet aggregation and platelet-leukocyte aggregation studies were performed at days 1 and 30. Primary outcomes including recurrent ischemic stroke, neurologic deterioration, periphery vascular events, and myocardial infarction were monitored. Safety endpoints were hemorrhagic episodes and death.
The prevalence of neurologic deterioration and recurrent ischemic stroke were lower in patients in the combination therapy group than in those of the monotherapy group (3.52% versus 9.78% and 1.76% versus 6.29%, respectively). At day 30 of treatment, the platelet aggregations and platelet-leukocyte aggregates were lower in patients who were treated with clopidogrel and aspirin than in patients given aspirin alone (P < .001).
For patients with acute large-artery atherosclerosis stroke, treatment with clopidogrel and aspirin for 1 month provided significantly greater inhibition of platelet activity than aspirin alone. Thus, dual therapy can be safer and more effective in reducing ischemic stroke recurrence and neurologic deterioration.
抗血小板药物被推荐用于急性非心源性卒中患者。然而，很少有随机临床试验研究这些患者双联抗血小板治疗的安全性和有效性。本研究的目的是评估氯吡格雷与阿司匹林联合治疗（联合治疗）和单用阿司匹林（单药治疗）对急性大动脉粥样硬化性卒中患者神经功能恶化、血小板活化及其他短期结局的影响。
共574例急性（≤2天）大动脉粥样硬化性卒中患者被随机分配接受氯吡格雷与阿司匹林联合治疗或单用阿司匹林治疗。在第1天和第30天进行血小板聚集和血小板-白细胞聚集研究。监测主要结局，包括复发性缺血性卒中、神经功能恶化、外周血管事件和心肌梗死。安全性终点为出血事件和死亡。
联合治疗组患者神经功能恶化和复发性缺血性卒中的发生率低于单药治疗组（分别为3.52%对9.78%和1.76%对6.29%）。在治疗第30天时，接受氯吡格雷与阿司匹林治疗的患者血小板聚集和血小板-白细胞聚集低于单用阿司匹林治疗的患者（P<0.001）。
对于急性大动脉粥样硬化性卒中患者，氯吡格雷与阿司匹林联合治疗1个月比单用阿司匹林能更显著地抑制血小板活性。因此，双联治疗在降低缺血性卒中复发和神经功能恶化方面可能更安全、更有效。
