Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi Province, 030001, China.
Department of Neurology, General Hospital of Tisco (Sixth Hospital of Shanxi Medical University), Taiyuan, 030008, China.
Ann Clin Transl Neurol. 2022 Apr;9(4):506-514. doi: 10.1002/acn3.51541. Epub 2022 Mar 12.
Subsequent vascular events are common after acute ischemic stroke during hospitalization. This study aimed to analyze the effectiveness of combination therapy with clopidogrel and aspirin among mild-to-moderate ischemic stroke patients treated within 72 h on the basis of a high-intensity dose of statins.
In a retrospective and multicenter cohort study, acute (within 72 h of onset) mild-to-moderate stroke patients were divided into aspirin and clopidogrel-aspirin groups on the basis of a high-intensity dose of statin therapy. The primary outcome was compound vascular events during hospitalization. Cox's proportional hazards model was used to assess differences, with the study center as a random effect.
Among the 506 patients meeting the eligibility criteria, all subjects received a high-intensity dose of statins, including 20 mg rosuvastatin or 40 mg atorvastatin while in the hospital. In an unadjusted analysis, compound vascular events occurred in 7.2% of patients in the clopidogrel-aspirin group compared with 13.7% of those in the aspirin group (p = 0.022). In a Cox proportional hazards regression analysis, clopidogrel-aspirin was associated with a lower risk of compound vascular events (hazard ratio [95% CI], 0.47 [0.25-0.87]; p = 0.017) and ischemic vascular events (p = 0.008). Moderate and severe hemorrhage occurred in four patients (1.07%) in the clopidogrel-aspirin group and three patients (2.30%) in the aspirin group (p = 0.626).
In this study based on high-intensity statin therapy, clopidogrel-aspirin reduced the risk of compound vascular events and did not increase the risk of hemorrhage during patients' hospitalization after mild-to-moderate ischemic stroke within 72 h.
急性缺血性脑卒中住院期间，后续血管事件较为常见。本研究旨在分析在高强度他汀剂量基础上，对发病 72 h 内接受治疗的轻中度缺血性脑卒中患者应用氯吡格雷联合阿司匹林治疗的效果。
本回顾性、多中心队列研究根据高强度他汀剂量治疗方案，将急性（发病后 72 h 内）轻中度脑卒中患者分为阿司匹林组和氯吡格雷-阿司匹林组。主要终点为住院期间复合血管事件。采用 Cox 比例风险模型评估差异，以研究中心为随机效应。
在符合入选标准的 506 例患者中，所有患者均在住院期间接受高强度他汀剂量治疗，包括 20 mg 瑞舒伐他汀或 40 mg 阿托伐他汀。未经校正分析，氯吡格雷-阿司匹林组患者的复合血管事件发生率为 7.2%，阿司匹林组为 13.7%（p=0.022）。在 Cox 比例风险回归分析中，氯吡格雷-阿司匹林与复合血管事件（风险比[95%CI]，0.47[0.25-0.87]；p=0.017）和缺血性血管事件（p=0.008）风险降低相关。氯吡格雷-阿司匹林组有 4 例（1.07%）患者发生中重度出血，阿司匹林组有 3 例（2.30%）（p=0.626）。
在本项基于高强度他汀治疗的研究中，氯吡格雷联合阿司匹林可降低轻中度缺血性脑卒中患者发病后 72 h 内住院期间复合血管事件的风险，且不会增加出血风险。
