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Stroke:氯吡格雷并不能预防急性动脉粥样硬化性卒中后复发缺血性病变

2016-07-15 MedSci MedSci原创

在大动脉粥样硬化造成的急性缺血性脑卒中患者中,氯吡格雷联合阿司匹林与单独阿司匹林治疗相比可能会更有效的防止复发性脑缺血。但是,目前还没有明确的证据。在这项多中心,双盲,安慰剂对照试验中,研究人员随机分配358例假定大动脉粥样硬化起源的急性缺血性卒中患者在发病48小时内接受氯吡格雷(75mg/d无负荷剂量)加阿司匹林(100mg/d后300mg负荷),或接受单独阿司匹林(300 mg负荷后100mg

在大动脉粥样硬化造成的急性缺血性脑卒中患者中,氯吡格雷联合阿司匹林与单独阿司匹林治疗相比可能会更有效的防止复发性脑缺血。但是,目前还没有明确的证据。

在这项多中心,双盲,安慰剂对照试验中,研究人员随机分配358例假定大动脉粥样硬化起源的急性缺血性卒中患者在发病48小时内接受氯吡格雷(75mg/d无负荷剂量)加阿司匹林(100mg/d后300mg负荷),或接受单独阿司匹林(300 mg负荷后100mg/d)共30天。主要成果是在30天内磁共振成像发现的新症状或无症状的缺血性病变。次要终点是30天的功能障碍,临床卒中复发和主要血管事件的复合事件。安全性结果是任何出血事件。

在358例患者中,334例(每组167例)完成随访的磁共振成像。在氯吡格雷联合阿司匹林和阿司匹林单药治疗组之间的30天的新的缺血性病变复发率具有可比性(36.5% vs 35.9%;相对危险度,1.02; 95%置信区间,0.77-1.35; P =0.91)。复发性缺血性病变中,94.2%为临床症状。2组之间的次要结果没有差异。联合组的任何出血事件比单用阿司匹林组发生更频繁,但差异不显著(16.7% vs 10.7%,P=0.11)。在氯吡格雷联合阿司匹林组发生1例出血性卒中。

对于预防大动脉动脉粥样硬化引起的急性缺血性卒中患者的新的缺血性病变和临床血管事件,氯吡格雷联合阿司匹林可能不优于单用阿司匹林。

原始出处:

Keun-Sik Hong, Seung-Hoon Lee,Eung Gyu Kim,et al.Recurrent Ischemic Lesions After Acute Atherothrombotic Stroke,Stroke,2016.7.14

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    2016-10-11 ylzr123

    学习了,好文值得点赞!

    0

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