Albright Karen C, Howard Virginia J, Howard George
Departments of Neurology and Pharmacology (KCA), SUNY Upstate Medical University, Syracuse, NY; Department of Epidemiology (VJH), and Department of Biostatistics (GH), School of Public Health, University of Alabama at Birmingham.
Neurol Clin Pract. 2021 Apr;11(2):e121-e128. doi: 10.1212/CPJ.0000000000000842.
Four seminal randomized controlled trials (RCTs) have investigated aspirin, aspirin plus extended-release dipyridamole, and clopidogrel for the prevention of recurrent vascular events. Despite studying over 32,000 patients with stroke in these trials, the decision on which antiplatelet agent to select for secondary stroke prevention remains controversial. Attempts to translate the results of these RCTs into clinical practice are complicated by each trial's selection of participants and choice of primary outcome. Herein, we argue that by examining RCT results with participant selection limited to patients with ischemic stroke or TIA and by focusing on recurrent stroke as our outcome, we can use the standard epidemiology 2 × 2 table to assist in selecting an antiplatelet agent for secondary stroke prevention.
四项重要的随机对照试验（RCT）研究了阿司匹林、阿司匹林加缓释双嘧达莫以及氯吡格雷用于预防血管事件复发的效果。尽管在这些试验中研究了超过32000例中风患者，但对于二级预防中选择哪种抗血小板药物的决策仍存在争议。由于每项试验的参与者选择和主要结局的选择，将这些RCT结果转化为临床实践的尝试变得复杂。在此，我们认为，通过将参与者选择限于缺血性中风或短暂性脑缺血发作（TIA）患者来检查RCT结果，并将复发性中风作为我们的结局，我们可以使用标准的流行病学2×2表来协助选择用于二级预防的抗血小板药物。
