Nishi Ryoji, Mano Tomoo, Kobayashi Yosuke, Matsuo Koji, Kobayashi Yasushi
Department of Neurology, Okazaki City Hospital.
Brain Nerve. 2016 Feb;68(2):181-9. doi: 10.11477/mf.1416200370.
Treatment to prevent progressive neurological deficits in acute penetrating artery infarction (API) is clinically important, but has not yet been established. This study aims to investigate the efficacy and safety of argatroban, aspirin, and clopidogrel combination therapy for API. Patients with API (lacunar infarcts or branch atheromatous disease) admitted within 48 hours after onset were enrolled. We assigned them to argatroban, aspirin, and clopidogrel (AAC) group or argatroban and aspirin (AA) group. In both groups, blood pressure was controlled to near or below 180/105 mmHg in the admission period. We defined progressing stroke as a worsening of two or more points in the National Institutes of Health Stroke Scale score on the seventh day of admission. Fifty-four patients were enrolled. We assigned 28 patients to the AAC group, and 26 patients to the AA group. There were no significant differences in background factors between the two groups. The incidence of progressing stroke was significantly higher in the AA group (P<0.05). Intracranial hemorrhage or any other bleeding was not seen in the admission period in either group. Our findings suggest that the AAC combination therapy may positively affect progressive neurological deficits in API patients.
预防急性穿支动脉梗死（API）进展性神经功能缺损的治疗在临床上具有重要意义，但尚未确立。本研究旨在探讨阿加曲班、阿司匹林和氯吡格雷联合治疗API的疗效和安全性。纳入发病后48小时内入院的API患者（腔隙性梗死或分支动脉粥样硬化病）。我们将他们分为阿加曲班、阿司匹林和氯吡格雷（AAC）组或阿加曲班和阿司匹林（AA）组。两组在入院期间均将血压控制在180/105 mmHg或以下。我们将进展性卒中定义为入院第7天美国国立卫生研究院卒中量表评分恶化2分或更多。共纳入54例患者。我们将28例患者分配到AAC组，26例患者分配到AA组。两组间的基线因素无显著差异。AA组进展性卒中的发生率显著更高（P<0.05）。两组在入院期间均未出现颅内出血或任何其他出血情况。我们的研究结果表明，AAC联合治疗可能对API患者的进展性神经功能缺损产生积极影响。
