Droste D W, Sonne M, Siemens H J, Kaps M
Department of Neurology, Medical University Lübeck, Germany.
Neurol Res. 1996 Oct;18(5):449-53. doi: 10.1080/01616412.1996.11740450.
Aspirin and ticlopidine are two commonly used drugs in the prevention of cerebral embolic ischemic events. No direct comparisons in a cross-over design of the effects of ticlopidine and aspirin on asymptomatic circulating cerebral microemboli are available. We investigated 53 patients with cerebrovascular disease. Twenty-six patients were dosed for 2 weeks, 300 mg aspirin once daily and then for 2 weeks, 250 mg ticlopidine twice daily. In 27 other patients the scheme was reversed. Transcranial Doppler monitoring (both middle cerebral arteries simultaneously for 1 h were performed at the end of the two weeks. The signal was recorded on digitalised audio tapes and analyzed blinded off-line. The number of embolic signals per hour and vessel was 15.7 under aspirin and 11.7 under ticlopidine (difference not significant). The correlation between the number of emboli under the two medications was high. The highest number of embolic signals was found in high grade carotid stenosis. In patients with a low number of embolic signals, reproducibility was low. A minimum of 7 embolic signals in one treatment group is required for further therapeutic drug trials to allow reasonable comparisons. This study may help to plan further therapeutic trials using emboli detection.
阿司匹林和噻氯匹定是预防脑栓塞性缺血事件常用的两种药物。目前尚无噻氯匹定和阿司匹林对无症状循环脑微栓子影响的交叉设计直接比较。我们研究了53例脑血管疾病患者。26例患者先服用2周，每日一次300毫克阿司匹林，然后服用2周，每日两次250毫克噻氯匹定。另外27例患者用药方案相反。在两周结束时进行经颅多普勒监测（同时对双侧大脑中动脉监测1小时）。信号记录在数字化录音带上并进行离线盲法分析。每小时和每条血管的栓子信号数量在阿司匹林治疗下为15.7，在噻氯匹定治疗下为11.7（差异无统计学意义）。两种药物治疗下栓子数量之间的相关性很高。在重度颈动脉狭窄患者中发现的栓子信号数量最多。在栓子信号数量少的患者中，可重复性较低。为了进行合理比较，进一步的治疗药物试验需要一个治疗组中至少有7个栓子信号。本研究可能有助于规划使用栓子检测的进一步治疗试验。
