From the Department of Pharmacy (Algarni), King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia, from the Department of Pharmacy Practice (Althagafi, Alshehri, Alshibani), Faculty of Pharmacy, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia, and from the College of Pharmacy (Alshargi), Riyadh Elm University, Riyadh, Kingdom of Saudi Arabia.
Neurosciences (Riyadh). 2023 Oct;28(4):220-226. doi: 10.17712/nsj.2023.4.20230021.
To compare the effectiveness of aspirin-clopidogrel dual antiplatelet therapy (DAPT) with aspirin or clopidogrel antiplatelet monotherapy (AM) in patients with ischemic stroke.
It was a single-center, retrospective cross-sectional study of medical records of ischemic stroke patients admitted at King Abdulaziz University Hospital between January 2015 and October 2019. The primary endpoints were ischemic stroke recurrence, rehospitalization, and all-cause mortality between DAPT and AM. Kaplan-Meier and Cox proportional hazard analyses were employed in univariate and multivariate time-to-event analyses.
The median time to recurrence of ischemic stroke was 15.0 months (95% confidence interval [CI], 8.586-23.01) for DAPT and 20.4 months (95% CI, 9.872-30.928) for the AM. The median survival time until all-cause mortality was 8.0 months (95% CI, 2.893-13.107) for DAPT and 14.1 months (95% CI, 8.173-19.97) for the AM. No statistically significant reductions in the instantaneous risks of recurrence (hazard ratio [HR], 1.27; 95% CI, 0.59-2.72; =0.54), re-hospitalization (HR, 0.95; 95% CI, 0.59-1.48; = 0.77), and mortality (HR, 1.04; 95% CI, 0.48-2.26; =0.92) were found between the DAPT and AM groups.
The DAPT was not superior to AM in reducing recurrence and mortality events in patients with ischemic stroke. Rehospitalization due to the sequelae of the composite of stroke, angina, and myocardial infarction was higher in the DAPT group.
比较缺血性脑卒中患者应用阿司匹林-氯吡格雷双联抗血小板治疗（DAPT）与阿司匹林或氯吡格雷单药抗血小板治疗（AM）的疗效。
这是一项单中心、回顾性、病历交叉研究，纳入 2015 年 1 月至 2019 年 10 月在阿卜杜勒阿齐兹国王大学医院住院的缺血性脑卒中患者。主要终点为 DAPT 与 AM 之间缺血性脑卒中复发、再住院和全因死亡率。采用 Kaplan-Meier 法和 Cox 比例风险分析进行单因素和多因素生存时间分析。
DAPT 组缺血性脑卒中复发的中位时间为 15.0 个月（95%CI，8.586-23.01），AM 组为 20.4 个月（95%CI，9.872-30.928）。DAPT 组全因死亡的中位生存时间为 8.0 个月（95%CI，2.893-13.107），AM 组为 14.1 个月（95%CI，8.173-19.97）。DAPT 组与 AM 组之间，复发的即时风险（风险比 [HR]，1.27；95%CI，0.59-2.72；=0.54）、再住院（HR，0.95；95%CI，0.59-1.48；=0.77）和死亡率（HR，1.04；95%CI，0.48-2.26；=0.92）均无统计学显著差异。
DAPT 并不能降低缺血性脑卒中患者的复发和死亡事件。DAPT 组因中风、心绞痛和心肌梗死的复合后遗症再住院的发生率更高。
