Yang Cheng, Qian Jie, Tang Xun, Gao Pei, Hu Yonghua
Department of Epidemiology and Biostatistics, Peking University Health Science Center, Beijing 100191, China.
Department of Epidemiology and Biostatistics, Peking University Health Science Center, Beijing 100191, China; Email:
Zhonghua Liu Xing Bing Xue Za Zhi. 2015 Dec;36(12):1430-5.
To present the systematic assessment on the efficacy and bleeding adverse events of dual-antiplatelet therapy with aspirin and clopidogrel versus aspirin-mono-antiplatelet therapy in patients with ischemic stroke or transient ischemic attack.
Retrieve randomized controlled trials conformed to the inclusion and exclusion criteria in Cochrane Library, Medline, Embase, and Web of Science electronic database, between January 1, 1998 and April 1, 2015. Cochrane Collaboration was used to assess the methodological quality of the included research papers. Stratification analysis was performed on factors as: race, subtypes of the disease, duration of follow-up and with or without clopidogrel loading dose, of the patients.
A total of 7 studies were eligible for analysis, including 14 022 study objects. Data from Meta-analysis showed that dual-antiplatelet therapy, when compared to the mono-therapy group, could reduce the risk of recurrent stroke (RR=0.71, 95%CI: 0.61-0.84, P<0.001) , at the same time, increase the risk of bleeding events (RR=1.60, 95%CI: 1.46-1.76, P<0.001). Data derived from the Hierarchical analysis showed that the risk of stroke recurrence in Chinese population (RR=0.55, 95%CI: 0.34-0.89) was lower than recorded in other populations (RR=0.78, 95%CI: 0.66-0.93) , with the risks of bleeding events as RR=1.41 (95%CI: 1.01-1.96) and RR=1.62 (95%CI: 1.47-1.79) , respectively. Risk of recurrence among the group with clopidogrel loading dose (RR=0.69, 95%CI: 0.58-0.81) was less than those without (RR=0.74, 95%CI:0.56-0.99). The risks of occurrence on bleeding events were RR=1.59 (95%CI: 1.10-2.30) and RR=1.60 (95%CI: 1.46-1.77) , respectively.
The combined therapy of aspirin and clopidogrel could reduce the risk of recurrence of ischemic stroke and TIA patients, but increase the risk of bleeding, when compared to the group that using aspirin alone for the therapy. In Chinese population, the combined therapy seemed more effective than using aspirin alone in reducing the recurrence of stroke, but without increasing the risk of bleeding.
对阿司匹林联合氯吡格雷双重抗血小板治疗与阿司匹林单药抗血小板治疗在缺血性卒中或短暂性脑缺血发作患者中的疗效及出血不良事件进行系统评价。
检索1998年1月1日至2015年4月1日期间，Cochrane图书馆、Medline、Embase和Web of Science电子数据库中符合纳入和排除标准的随机对照试验。采用Cochrane协作网方法评估纳入研究论文的方法学质量。对患者的种族、疾病亚型、随访时间以及是否使用氯吡格雷负荷剂量等因素进行分层分析。
共有7项研究符合分析条件，包括14022例研究对象。Meta分析数据显示，与单药治疗组相比，双重抗血小板治疗可降低卒中复发风险（RR=0.71，95%CI：0.61-0.84，P<0.001），同时增加出血事件风险（RR=1.60，95%CI：1.46-1.76，P<0.001）。分层分析数据显示，中国人群卒中复发风险（RR=0.55，95%CI：0.34-0.89）低于其他人群（RR=0.78，95%CI：0.66-0.93），出血事件风险分别为RR=1.41（95%CI：1.01-1.96）和RR=1.62（95%CI：1.47-1.79）。使用氯吡格雷负荷剂量组的复发风险（RR=0.69，95%CI：0.58-0.81）低于未使用者（RR=0.74，95%CI：0.56-0.99）。出血事件发生风险分别为RR=1.59（95%CI：1.10-2.30）和RR=1.60（95%CI：1.46-1.77）。
与单用阿司匹林治疗组相比，阿司匹林联合氯吡格雷治疗可降低缺血性卒中和短暂性脑缺血发作患者的复发风险，但增加出血风险。在中国人群中，联合治疗在降低卒中复发方面似乎比单用阿司匹林更有效，且不增加出血风险。
