阿司匹林联合氯吡格雷在急性高危非致残性缺血性脑血管病治疗中的应用研究
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摘要
目的研究氯吡格雷联合阿司匹林治疗急性高危非致残性缺血性脑血管病(HR-NICE)的疗效及安全性。方法将急性HR-NICE患者随机分为阿司匹林组(160例)和阿司匹林、氯吡格雷联合治疗组(198例),分别给予药物治疗。比较两组患者临床疗效,治疗前后凝血指标水平,以及并发症发生情况。结果联合治疗组治疗总有效率为87.87%,高于阿司匹林组(71.87%,P<0.05),联合治疗组与阿司匹林组治疗前后血小板、活化部分凝血酶时间及凝血酶原时间水平比较差异无统计学意义(P>0.05)。治疗期间,两组患者并发症发生率比较差异无统计学意义(P>0.05)。结论氯吡格雷联合阿司匹林治疗急性HR-NICE,疗效较佳、安全性高,可推广应用。
Objective To observe the clinical efficacy and safety of clopidogrel combined with aspirin in the treatment of acute high risk non-ischemic ischemic cerebrovascular events(HR-NICE).Methods Patients with acute HR-NICE were randomly divided into aspirin group(160 cases)and aspirin combined with clopidogrel group(198 cases).The clinical efficacy,coagulation parameters and adverse reactions of the two groups before and after treatment were observed and compared.Results After treatment,the total effective rate of aspirin combined with clopidogrel group was 87.87%,higher than the 71.87% of aspirin group(P<0.05).There was no significant differences in the levels of platelet,prothrombin time and activated partial thromboplastin time between the combined treatment group and the aspirin group(P>0.05).During treatment,there was no significant difference in the incidence of complications between the two groups(P>0.05).Conclusion Clopidogrel combined with aspirin could be effective and safe in the treatment of acute HR-NICE.
Objective To observe the clinical efficacy and safety of clopidogrel combined with aspirin in the treatment of acute high risk non-ischemic ischemic cerebrovascular events(HR-NICE).Methods Patients with acute HR-NICE were randomly divided into aspirin group(160 cases)and aspirin combined with clopidogrel group(198 cases).The clinical efficacy,coagulation parameters and adverse reactions of the two groups before and after treatment were observed and compared.Results After treatment,the total effective rate of aspirin combined with clopidogrel group was 87.87%,higher than the 71.87% of aspirin group(P<0.05).There was no significant differences in the levels of platelet,prothrombin time and activated partial thromboplastin time between the combined treatment group and the aspirin group(P>0.05).During treatment,there was no significant difference in the incidence of complications between the two groups(P>0.05).Conclusion Clopidogrel combined with aspirin could be effective and safe in the treatment of acute HR-NICE.
引文
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[12]COULL AJ,LOVETT JK,ROTHWELL PM,et al.Population based study of early risk of stroke after transient ischaemic attack or minor stroke:implications for public education and organisation of services[J].Br Med J,2004,328(7435):326-328.
[13]JI RJ,LIU GF,SHEN HP,et al.Persistence of secondary prevention medications after acute ischemic stroke or transient ischemic attack in Chinese population:data from China National Stroke Registry[J].Neurol Res,2013,35(1):29-36.
[14]LUENGO-FERNANDEZ R,GRAY AM,ROTHWELL PM.Effect of urgent treatment for transient ischaemic attack and minor stroke on disability and hospital costs(express study):aprospective population-based sequential comparison[J].Lancet Neurol,2009,8(3):235-243.
[15]MARKUS HS,DROSTE DW,KAPS M,et al.Dual antiplatelet therapy with clopidogrel and aspirin in symptomatic carotid stenosis evaluated using doppler embolic signal detection:the Clopidogrel and Aspirin for Reduction of Emboli in Symptomatic Carotid Stenosis(CARESS)trial[J].Circulation,2005,111(17):2233-2240.
[16]HUIBERS A,HALLIDAY A,BULBULIA R,et al.Antiplatelet therapy in carotid artery stenting and carotid endarterectomy in the asymptomatic carotid surgery trial-2[J].Eur J Vasc Endovasc Surg,2016,51(3):336-342.
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[18]FIOLAKI A,KATSANOS AH,KYRITSIS AP,et al.High on treatment platelet reactivity to aspirin and clopidogrel in ischemic stroke:A systematic review and meta-analysis[J].J Neurol Sci,2017,376(1):112-116.
[19]短暂性脑缺血发作中国专家共识组.短暂性脑缺血发作与轻型卒中抗血小板治疗中国专家共识(2014年)[J].实用心脑肺血管病杂志,2014,94(10):33.
[20]崔亚娇,戴媛媛,杨迪,等.抗血小板药物联用在缺血性脑卒中二级预防的研究进展[J].临床合理用药杂志,2017,10(10):166-167.
[2]王伊龙,赵性泉,刘新峰,等.高危非致残性缺血性脑血管事件诊疗指南[J].中国卒中杂志,2016,11(6):481-491.
[3]BEJOT Y,DAUBAIL B,GIROUD M.Epidemiology of stroke and transient ischemic attacks:current knowledge and perspectives[J].Rev Neurol(Paris),2016,172(1):59-68.
[4]付立臣.氯吡格雷联合阿司匹林治疗短暂性脑缺血患者的临床疗效观察[J].中国民康医学,2015,27(19):30-31.
[5]王红瑜.不同药物治疗短暂性脑缺血发作的临床对照观察[J].中国实用医药,2014,27(14):161-162.
[6]PAN YE,WANG AX,LIU GF,et al.Cost-effectiveness of clopidogrel-aspirin versus aspirin alone for acute transient ischemic attack and minor stroke[J].J Am Heart Assoc,2014,3(3):760-767.
[7]SEADON S,LANG E.Clopidogrel with aspirin versus aspirin alone in prevention of stroke following transient ischemic attack or acute minor stroke[J].CJEM,2015,16(3):38-40.
[8]LI Z,WANG Y,ZHAO X,et al.Treatment effect of clopidogrel plus aspirin within 12hours of acute minor stroke or transient ischemic attack[J/OL].J Am Heart Assoc,(2016-03-21)[2019-03-07].https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4943275/.
[9]王拥军.重视非致残性高危缺血性脑血管事件[J].中华内科杂志,2015,54(9):745-746.
[10]CHU TT,YU WD,WANG YY,et al.The ABCD2score May underestimate the short-term risk of stroke in Chinese population:a meta-analysis[J].Neuro Endocrinol Lett,2015,36(3):262-268.
[11]黄环,粟伟栋,谭红.高危非致残性缺血性脑血管事件治疗进展[J].神经病学与神经康复学杂志,2018,14(1):33-37.
[12]COULL AJ,LOVETT JK,ROTHWELL PM,et al.Population based study of early risk of stroke after transient ischaemic attack or minor stroke:implications for public education and organisation of services[J].Br Med J,2004,328(7435):326-328.
[13]JI RJ,LIU GF,SHEN HP,et al.Persistence of secondary prevention medications after acute ischemic stroke or transient ischemic attack in Chinese population:data from China National Stroke Registry[J].Neurol Res,2013,35(1):29-36.
[14]LUENGO-FERNANDEZ R,GRAY AM,ROTHWELL PM.Effect of urgent treatment for transient ischaemic attack and minor stroke on disability and hospital costs(express study):aprospective population-based sequential comparison[J].Lancet Neurol,2009,8(3):235-243.
[15]MARKUS HS,DROSTE DW,KAPS M,et al.Dual antiplatelet therapy with clopidogrel and aspirin in symptomatic carotid stenosis evaluated using doppler embolic signal detection:the Clopidogrel and Aspirin for Reduction of Emboli in Symptomatic Carotid Stenosis(CARESS)trial[J].Circulation,2005,111(17):2233-2240.
[16]HUIBERS A,HALLIDAY A,BULBULIA R,et al.Antiplatelet therapy in carotid artery stenting and carotid endarterectomy in the asymptomatic carotid surgery trial-2[J].Eur J Vasc Endovasc Surg,2016,51(3):336-342.
[17]DIENER HC,BOGOUSSLAVSKY J,BRASS LM,et al.Aspirin and clopidogrel compared with clopidogrel alone after recent ischaemic stroke or transient ischaemic attack in high-risk patients(MATCH):randomised,double-blind,placebo-controlled trial[J].Lancet,2004,364(9431):331-337.
[18]FIOLAKI A,KATSANOS AH,KYRITSIS AP,et al.High on treatment platelet reactivity to aspirin and clopidogrel in ischemic stroke:A systematic review and meta-analysis[J].J Neurol Sci,2017,376(1):112-116.
[19]短暂性脑缺血发作中国专家共识组.短暂性脑缺血发作与轻型卒中抗血小板治疗中国专家共识(2014年)[J].实用心脑肺血管病杂志,2014,94(10):33.
[20]崔亚娇,戴媛媛,杨迪,等.抗血小板药物联用在缺血性脑卒中二级预防的研究进展[J].临床合理用药杂志,2017,10(10):166-167.