School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei, Taiwan; Department of Pharmacy, Shuang Ho Hospital, Taipei Medical University, New Taipei, Taiwan.
School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan.
Mayo Clin Proc. 2022 Aug;97(8):1483-1492. doi: 10.1016/j.mayocp.2022.01.033.
To evaluate the risks of recurrent stroke and major bleeding events with clopidogrel and aspirin use among patients aged 80 years or older.
This retrospective cohort study was conducted using the Full Population Data of the Health and Welfare Database in Taiwan. Patients aged 80 years or older who received monotherapy with clopidogrel or aspirin following hospitalization for primary acute ischemic stroke between January 1, 2009, and December 31, 2018, were included. Inverse probability of treatment weighting was used to balance measured covariates between clopidogrel and aspirin users. Measured outcomes included recurrent acute ischemic stroke, acute myocardial infarction, composite cardiovascular events (recurrent stroke or acute myocardial infarction), intracranial hemorrhage, major gastrointestinal tract bleeding, and composite major bleeding events (intracranial hemorrhage or major gastrointestinal tract bleeding).
A total of 15,045 patients were included in the study, 1979 of whom used clopidogrel and 13,066 who used aspirin following hospitalization for primary acute ischemic stroke. Clopidogrel use was associated with significantly lower risk of recurrent acute ischemic stroke (hazard ratio [HR], 0.89; 95% CI, 0.83 to 0.96; P=.002), composite cardiovascular events (HR, 0.88; 95% CI, 0.82 to 0.95; P<.001), intracranial hemorrhage (HR, 0.71; 95% CI, 0.56 to 0.90; P=.005), and composite major bleeding events (HR, 0.89; 95% CI, 0.80 to 0.99; P=.04) compared with aspirin use.
In patients aged 80 years or older with primary acute ischemic stroke, clopidogrel users had lower risks of recurrent stroke and the composite cardiovascular events compared with aspirin users. Clopidogrel users also had lower risks of intracranial hemorrhage and the composite major bleeding events compared with aspirin users.
评估 80 岁及以上患者使用氯吡格雷和阿司匹林治疗复发性卒中及大出血事件的风险。
本回顾性队列研究使用了台湾全民健康保险数据库的全人群数据。2009 年 1 月 1 日至 2018 年 12 月 31 日期间，因初次急性缺血性卒中住院后接受氯吡格雷或阿司匹林单药治疗的 80 岁及以上患者纳入本研究。采用逆概率治疗加权法平衡氯吡格雷和阿司匹林使用者之间的测量协变量。测量结局包括复发性急性缺血性卒中、急性心肌梗死、心血管复合事件（复发性卒中或急性心肌梗死）、颅内出血、主要胃肠道出血和复合大出血事件（颅内出血或主要胃肠道出血）。
共纳入 15045 例患者，其中 1979 例使用氯吡格雷，13066 例使用阿司匹林治疗初次急性缺血性卒中。与阿司匹林相比，氯吡格雷治疗与复发性急性缺血性卒中（风险比[HR]，0.89；95%置信区间[CI]，0.83 至 0.96；P=.002）、心血管复合事件（HR，0.88；95% CI，0.82 至 0.95；P<.001）、颅内出血（HR，0.71；95% CI，0.56 至 0.90；P=.005）和复合大出血事件（HR，0.89；95% CI，0.80 至 0.99；P=.04）的风险显著降低有关。
在初次急性缺血性卒中的 80 岁及以上患者中，与阿司匹林相比，氯吡格雷使用者的复发性卒中及心血管复合事件风险较低。与阿司匹林使用者相比，氯吡格雷使用者颅内出血及复合大出血事件风险也较低。
