Department of Neurology, University of Washington, Seattle, SA, USA.
Department of Pharmacy, University of Washington, Seattle, SA, USA.
Curr Cardiol Rep. 2021 Aug 19;23(10):145. doi: 10.1007/s11886-021-01581-5.
Antiplatelet therapy remains the standard of care in secondary stroke prevention for non-cardioembolic ischemic stroke and transient ischemic attack. We aim to examine the use of antiplatelet agents in secondary prevention through highlighting relevant clinical trials and meta-analyses as well as providing commentary regarding our practice.
In the POINT and CHANCE trials, dual antiplatelet therapy reduced recurrent stroke compared to aspirin monotherapy. Sub-analyses of these trials suggest that genetic polymorphisms could play a role in diminishing the effectiveness of clopidogrel. Similarly, THALES demonstrated better outcomes with ticagrelor-aspirin combination therapy over aspirin monotherapy. Combination antiplatelet therapy with aspirin and the P2Y12 inhibitors, clopidogrel and ticagrelor, reduced stroke recurrence in those presenting with mild ischemic stroke or high risk TIA. Genetic polymorphisms may play a role in determining the appropriate regimen. Questions remain regarding the optimal duration of combination antiplatelet therapy for various stroke etiologies.
抗血小板治疗仍然是非心源性缺血性卒中和短暂性脑缺血发作二级预防的标准治疗方法。我们旨在通过强调相关临床试验和荟萃分析，以及对我们的实践进行评论，来研究抗血小板药物在二级预防中的应用。
在 POINT 和 CHANCE 试验中，与阿司匹林单药治疗相比，双联抗血小板治疗可降低复发性卒中。这些试验的亚分析表明，遗传多态性可能在降低氯吡格雷的疗效方面发挥作用。同样，THALES 试验表明，替格瑞洛-阿司匹林联合治疗优于阿司匹林单药治疗，可带来更好的结局。阿司匹林联合 P2Y12 抑制剂（氯吡格雷和替格瑞洛）的双联抗血小板治疗可降低轻度缺血性卒中和高危 TIA 患者的卒中复发风险。遗传多态性可能在确定合适的治疗方案方面发挥作用。对于各种卒中病因，联合抗血小板治疗的最佳持续时间仍存在疑问。
