Rajkumar Christopher A, Floyd Christopher N, Ferro Albert
Department of Clinical Pharmacology, Cardiovascular Division, British Heart Foundation Centre of Research Excellence, King's College London, London, United Kingdom.
Br J Clin Pharmacol. 2015 Sep;80(3):331-41. doi: 10.1111/bcp.12630. Epub 2015 Jul 2.
Antiplatelet therapy reduces the incidence of ischaemic stroke. Platelet-mediated thrombosis contributes variably to the major subtypes of stroke as defined by the TOAST criteria: large artery atherosclerosis (LAA), cardioembolic (CE) and small vessel occlusion (SVO). The effect of antiplatelet therapy on the incidence of each subtype is unknown and is the subject of this meta-analysis.
Electronic databases were searched for articles comparing the effect of antiplatelet therapy on the incidence of stroke according to aetiological subtype. Studies containing subjects prescribed anticoagulant therapy or solely investigating subjects with atrial fibrillation were excluded. Pooled odds ratios (ORs) were calculated using a fixed effects model.
Nine studies were included (n = 5739). In patients who had an ischaemic stroke, pre-event antiplatelet therapy was associated with significantly decreased incidence of LAA (OR 0.88, 95% CI 0.79, 0.99; P = 0.026), increased incidence of CE (OR 1.23, 95% CI 1.08, 1.41; P = 0.002) and no effect on SVO (OR 0.99, 95% CI 0.88, 1.11; P = 0.806). Concordant non-significant trends were observed in primary prevention populations (n = 751): LAA (OR 0.81, 95% CI 0.57, 1.15; P = 0.240), CE (OR 1.29, 95% CI 0.89, 1.87; P = 0.179) and SVO (OR 0.99, 95% CI 0.73, 1.36; P = 0.970). Subgroup analysis of aspirin monotherapy (n = 3786) demonstrated a significant reduction in LAA (OR 0.87, 95% CI 0.76, 1.00; P = 0.046), but non-significant effects on the incidence of CE (OR 1.17, 95% CI 0.99, 1.39; P = 0.068) and SVO (OR 1.04, 95% CI 0.91, 1.20; P = 0.570). Probability of publication bias was low (P > 0.05).
Antiplatelet therapy preferentially reduces the incidence of LAA stroke compared with CE and SVO subtypes.
抗血小板治疗可降低缺血性卒中的发生率。血小板介导的血栓形成在由TOAST标准定义的主要卒中亚型中所起的作用各不相同，这些亚型包括：大动脉粥样硬化（LAA）、心源性栓塞（CE）和小血管闭塞（SVO）。抗血小板治疗对各亚型卒中发生率的影响尚不清楚，本荟萃分析旨在研究这一问题。
检索电子数据库，查找比较抗血小板治疗对不同病因亚型卒中发生率影响的文章。排除包含接受抗凝治疗受试者的研究或仅研究房颤受试者的研究。采用固定效应模型计算合并比值比（OR）。
纳入9项研究（n = 5739）。在发生缺血性卒中的患者中，事件前抗血小板治疗与LAA发生率显著降低相关（OR 0.88，95%CI 0.79，0.99；P = 0.026），CE发生率升高（OR 1.23，95%CI 1.08，1.41；P = 0.002），对SVO无影响（OR 0.99，95%CI 0.88，1.11；P = 0.806）。在一级预防人群（n = 751）中观察到一致的非显著趋势：LAA（OR 0.81，95%CI 0.57，1.15；P = 0.240），CE（OR 1.29，95%CI 0.89，1.87；P = 0.179）和SVO（OR 0.99，95%CI 0.73，1.36；P = 0.970）。阿司匹林单药治疗亚组分析（n = 3786）显示LAA显著降低（OR 0.87，95%CI 0.76，1.00；P = 0.046），但对CE发生率（OR 1.17，95%CI 0.99，1.39；P = 0.068）和SVO发生率（OR 1.04，95%CI 0.91，1.20；P = 0.570）无显著影响。发表偏倚的可能性较低（P > 0.05）。
与CE和SVO亚型相比，抗血小板治疗能更有效地降低LAA卒中的发生率。
