在缺血性中风后长达72小时的双重抗血小板治疗
Ying Gao1, Weiqi Chen1, Yuesong Pan1
1From the Department of Neurology, Beijing Tiantan Hospital (Y.G., W.C., Y.P., J.J., C.W., Y.Y., T.W., S.H., X.M., X.Z., L.L., Yongjun Wang, Yilong Wang), the Advanced Innovation Center for Human Brain Protection (Yongjun Wang, Yilong Wang), Beijing Laboratory of Oral Health (Yilong Wang), and Beijing Municipal Key Laboratory of Clinical Epidemiology (Yilong Wang), Capital Medical University, the China National Clinical Research Center for Neurological Diseases (Y.P., J.J., C.W., L.J., X.M., J.L., X.Z., L.L., Yongjun Wang, Yilong Wang), the National Center for Neurological Disorders (Yongjun Wang, Yilong Wang), the Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences (Yongjun Wang), and the Chinese Institute for Brain Research (Yilong Wang), Beijing, the Department of Neurology, Weihai Wendeng District People's Hospital, Weihai (J.Z.), the Department of Neurology, Sui Chinese Medical Hospital, Shangqiu (Y.L.), the Department of Neurology, Qinghe People's Hospital, Xingtai (Y.Z.), the Department of Neurology, Biyang People's Hospital, Zhumadian (S.Z.), the Department of Neurology, Jiyuan Chinese Medical Hospital, Jiyuan (H.Y.), the Department of Neurology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an (J.Y.), the Department of Neurology, Affiliated Shuyang Hospital of Xuzhou Medical University, Suqian (Yuanwei Wang), the Department of Neurology, Mengzhou People's Hospital (D. Li), and the Department of Neurology, Xiuwu People's Hospital (G.K.), Jiaozuo, and the Department of Neurology, Hejian People's Hospital, Cangzhou (Yanxia Wang, D. Liu) - all in China; the Department of Neurology, University of California, San Francisco, San Francisco (S.C.J.); the Department of Neurology and Stroke Center, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, INSERM Laboratory for Vascular Translational Science-Unité 1148, University of Paris, Paris (P.A.); the Population Health Research Institute, McMaster University, Hamilton, ON, Canada (P.A.); and the Stroke Trials Unit, Mental Health and Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom (P.M.B.).
与克洛皮多格勒和阿司匹林的双重抗血小板治疗,在急性缺血性中风的72小时内开始,与单独使用阿司匹林相比,降低了复发性中风的风险. 然而,这种联合治疗略微增加了中度至严重出血的风险.
科学领域:
- 神经学 神经学
- 心脏病学 心脏病学
- 药理学 药理学是指药理学的学科.
背景情况:
- 双重抗血小板治疗 (克洛皮多格雷尔加阿司匹林) 表明,在急性轻度中风后早期开始时,有望降低复发性中风风险.
- 由于动脉样硬化而导致的急性脑缺血症在72小时内服用克洛皮多格雷尔加阿司匹林与单独阿司匹林的疗效和安全性仍未得到充分研究.
研究的目的:
- 评估克洛皮多格雷尔加阿司匹林与单独阿司匹林相比在90天内预防新的中风的有效性.
- 评估安全性,特别是与这种双重抗血小板治疗相关的中度至重度出血的发生率.
主要方法:
- 在222家中国医院进行了一项双盲,随机,安慰剂对照试验.
- 6100名患有轻度缺血性中风或高风险的动脉样硬化起源的过渡性缺血性发作 (TIA) 的患者在症状出现后72小时内随机分组.
- 患者接受了克洛皮多格雷尔加阿司匹林或克洛皮多格雷尔安慰剂加阿司匹林,结果在90天后进行评估.
主要成果:
- 克洛皮多格雷尔-阿司匹林组的患者中有7.3%发生了新的中风,而仅服用阿司匹林组的患者为9.2% (危险比,0.79;P=0.008).
- 中度至严重的出血发生在0.9%的克洛皮多格雷尔-阿司匹林组,相比之下,阿司匹林组的0.4% (危险比,2.08;P=0.03).
结论:
- 在轻度缺血性中风或高风险TIA发生后72小时内启动皮格瑞尔-阿司匹林联合治疗,可显著降低90天内复发性中风的风险.
- 虽然有效,这种双重治疗与中度至重度出血风险的小但统计学上显著增加有关.
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