Tornyos Dániel, Bálint Alexandra, Kupó Péter, El Abdallaoui Oumaima El Alaoui, Komócsi András
Department of Interventional Cardiology, Heart Institute, Medical School, University of Pécs, Ifjúság útja 13, 7624 Pécs, Hungary.
Life (Basel). 2021 May 15;11(5):447. doi: 10.3390/life11050447.
Stroke embodies one of the leading causes of death and disability worldwide. We aimed to provide a comprehensive insight into the effectiveness and safety of antiplatelet agents and anticoagulants in the secondary prevention of ischemic stroke or transient ischemic attack. A systematic search for randomized controlled trials, comparing antiplatelet or anticoagulant therapy versus aspirin or placebo among patients with ischemic stroke or transient ischemic attack, was performed in order to summarize data regarding the different regimens. Keyword-based searches in the MEDLINE, EMBASE, and Cochrane Library databases were conducted until the 1st of January 2021. Our search explored 46 randomized controlled trials involving ten antiplatelet agents, six combinations with aspirin, and four anticoagulant therapies. The review of the literature reflects that antiplatelet therapy improves outcome in patients with ischemic stroke or transient ischemic attack. Monotherapy proved to be an effective and safe choice, especially in patients with a high risk of bleeding. Intensified antiplatelet regimens further improve stroke recurrence; however, bleeding rate increases while mortality remains unaffected. Supplementing the clinical judgment of stroke treatment, assessment of bleeding risk is warranted to identify patients with the highest benefit of treatment intensification.
中风是全球主要的死亡和致残原因之一。我们旨在全面深入了解抗血小板药物和抗凝剂在缺血性中风或短暂性脑缺血发作二级预防中的有效性和安全性。为了总结不同治疗方案的数据，我们对缺血性中风或短暂性脑缺血发作患者中比较抗血小板或抗凝治疗与阿司匹林或安慰剂的随机对照试验进行了系统检索。在MEDLINE、EMBASE和Cochrane图书馆数据库中进行了基于关键词的检索，检索截至2021年1月1日。我们的检索共纳入了46项随机对照试验，涉及10种抗血小板药物、6种与阿司匹林的联合用药以及4种抗凝治疗。文献综述表明，抗血小板治疗可改善缺血性中风或短暂性脑缺血发作患者的预后。单一疗法被证明是一种有效且安全的选择，尤其是在出血风险较高的患者中。强化抗血小板治疗方案可进一步降低中风复发率；然而，出血率会增加，而死亡率不受影响。在补充中风治疗临床判断的同时，有必要评估出血风险，以确定从强化治疗中获益最大的患者。
