He Fan, Xia Cheng, Zhang Jing-Hua, Li Xiao-Qiu, Zhou Zhong-He, Li Feng-Peng, Li Wei, Lv Yan, Chen Hui-Sheng
Department of Neurology, General Hospital of Shen-Yang Military Region, 83 Wen Hua Road, Shen He District, Shen Yang 110840, PR China.
Department of Neurology, General Hospital of Shen-Yang Military Region, 83 Wen Hua Road, Shen He District, Shen Yang 110840, PR China.
J Clin Neurosci. 2015 Jan;22(1):83-6. doi: 10.1016/j.jocn.2014.05.038. Epub 2014 Sep 10.
Recent studies have suggested that combination antiplatelet therapy may be superior to monotherapy in the treatment of acute stroke. However, additional prospective studies are needed to confirm this finding. The present trial compared the efficacy and safety of clopidogrel plus aspirin versus aspirin alone in the treatment of non-cardioembolic ischemic stroke within 72 hours of onset. Six hundred and ninety patients aged ⩾ 40 years with minor stroke or transient ischemic attack (TIA) were identified for enrollment. Experienced physicians determined baseline National Institutes of Health Stroke Scale scores at the time of admission. All patients were randomly allocated (1:1) to receive aspirin alone (300 mg/day) or clopidogrel (300 mg for the first day, 75 mg/day thereafter) plus aspirin (100mg/day). The main endpoints were neurological deterioration, recurrent stroke, and development of stroke in patients with TIA within 14 days of admission. After 43 patients were excluded, 321 patients in the dual therapy group and 326 patients in the monotherapy group completed the treatment. Baseline characteristics were similar between groups. During the 2 week period, stroke deterioration occurred in nine patients in the dual therapy group and 19 patients in the monotherapy group. Stroke occurred after TIA in one patient in the dual therapy group and three patients in the monotherapy group. Similar numbers of adverse events occurred in both groups. This study showed that early dual antiplatelet treatment reduced early neurological deterioration in patients with acute ischemic stroke, compared with antiplatelet monotherapy. These results imply that dual antiplatelet therapy is superior to monotherapy in the early treatment of acute ischemic stroke.
近期研究表明，在急性中风的治疗中，联合抗血小板治疗可能优于单一疗法。然而，需要更多前瞻性研究来证实这一发现。本试验比较了氯吡格雷联合阿司匹林与单用阿司匹林治疗发病72小时内非心源性缺血性中风的疗效和安全性。690名年龄≥40岁的轻度中风或短暂性脑缺血发作（TIA）患者被纳入研究。经验丰富的医生在入院时确定基线美国国立卫生研究院卒中量表评分。所有患者被随机分配（1:1）接受单用阿司匹林（300毫克/天）或氯吡格雷（首日300毫克，此后75毫克/天）加阿司匹林（100毫克/天）治疗。主要终点为入院14天内患者的神经功能恶化、复发性中风以及TIA患者中风的发生情况。在排除43名患者后，双联治疗组321名患者和单药治疗组326名患者完成了治疗。两组的基线特征相似。在2周期间，双联治疗组有9名患者出现中风恶化，单药治疗组有19名患者出现中风恶化。双联治疗组有1名患者在TIA后发生中风，单药治疗组有3名患者在TIA后发生中风。两组发生不良事件的数量相似。本研究表明，与抗血小板单一疗法相比，早期双联抗血小板治疗可降低急性缺血性中风患者的早期神经功能恶化。这些结果表明，双联抗血小板治疗在急性缺血性中风的早期治疗中优于单一疗法。
