Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Acta Neurol Taiwan. 2023 Sep 30;32(3):138-144.
Antiplatelet therapy is the first-line management for noncardioembolic transient ischemic attack (TIA) and acute ischemic stroke (IS). Herein, we review the safety and efficacy of antiplatelet therapies in patients with IS and TIA, primarily focusing on the acute stage. We discuss current antiplatelet monotherapy and the factors influencing efficacy and continuation rate according to clinical trial data. Aspirin remains the most commonly used first-line antiplatelet agent for preventing noncardioembolic stroke recurrence, and clopidogrel, cilostazol, and ticagrelor are feasible alternatives. Various short-term dual antiplatelet therapies (including clopidogrel-aspirin and ticagrelor-aspirin combination therapy) for minor stroke and high-risk TIA are also reviewed. For selected patients with specific stroke etiologies, short-term dual antiplatelet therapy with aspirin combined with clopidogrel or ticagrelor can significantly reduce the risk of stroke. However, insufficient evidence supports the benefits of triple antiplatelet therapy for recurrent noncardioembolic stroke prevention, and this treatment substantially increases the rate of bleeding complications. Keyword: antiplatelet therapy, acute ischemic stroke, secondary prevention, transient ischemic attack.
抗血小板治疗是治疗非心源性短暂性脑缺血发作（TIA）和急性缺血性卒中（IS）的一线治疗方法。在此，我们主要讨论了 IS 和 TIA 患者抗血小板治疗的安全性和有效性，重点关注急性期。我们根据临床试验数据讨论了目前的抗血小板单药治疗以及影响疗效和持续率的因素。阿司匹林仍然是预防非心源性卒中复发最常用的一线抗血小板药物，氯吡格雷、西洛他唑和替格瑞洛是可行的替代药物。还回顾了各种用于小卒中和高危 TIA 的短期双联抗血小板治疗（包括氯吡格雷-阿司匹林和替格瑞洛-阿司匹林联合治疗）。对于具有特定卒中病因的特定患者，短期双联抗血小板治疗（阿司匹林联合氯吡格雷或替格瑞洛）可显著降低卒中风险。然而，缺乏证据支持三重抗血小板治疗对复发性非心源性卒中预防的益处，并且这种治疗会显著增加出血并发症的发生率。关键词：抗血小板治疗、急性缺血性卒中、二级预防、短暂性脑缺血发作。
