阿司匹林联合氯吡格雷治疗短暂性脑缺血发作的疗效观察

目的观察阿司匹林联合氯吡格雷治疗短暂性脑缺血发作(TIA)患者的有效性和安全性。方法选择150例TIA患者,随机分成3组:A组、B组和C组。A组给予阿司匹林100 mg/d;B组给予氯吡格雷75 mg/d;C组给予阿司匹林100 mg/d和氯吡格雷75 mg/d,对比分析3组患者于3个月的治疗过程中,TIA的复发率、脑梗死的发生率及不良反应发生率。结果 3组患者TIA复发率及脑梗死发生率相比较,A组与B组无明显差异(P>0.05),C组低于A组和B组,差异有统计学意义(P<0.05)。3组患者不良反应发生率差异无统计学意义(P>0.05)。结论阿司匹林联合氯吡格雷治疗TIA疗效确切,优于单一用药,可减少TIA发作,减少脑梗死发生率,且用药安全,不良反应发生率无明显增加。     

阿司匹林与氯吡格雷联用与阿司匹林单独应用在房颤性脑卒中后二级预防中的对比研究

目的 比较阿司匹林与氯吡格雷联用与阿司匹林单独应用在房颤性脑卒中后二级预防中的疗效及安全性.方法 对我院近五年来88例房颤性脑卒中后的高龄患者,在抗凝治疗二级预防中随机分成氯吡格雷与阿司匹林联合用药组和单用阿司匹林组,均在发生脑卒中或/短暂性脑缺血发作（TIA）的早期使用,联合用药组首日300 mg氯吡格雷后,以氯吡格雷75 mg＋阿司匹林75 mg/d;单独用药组阿司匹林100 mg/d.对两组患者进行长期密切随访,对患者脑卒中复发、TIA事件及不同类型出血事件统计分析,分别评价疗效与不良反应.结果 阿司匹林与氯吡格雷联合应用与阿司匹林单独应用相比,降低了房颤性脑卒中的发生（P〈0.05）;TIA发生率的比较则无显著差异（P〉0.05）;而联合用药组出血事件的总发生率亦较高（P〈0.05）.结论 与阿司匹林单独应用相比,阿司匹林与氯吡格雷联合应用在减少高龄房颤性脑卒中复发率方面更有效,但在随访期内不能减少TIA的发生率,却增加了出血的不良事件.     

阿司匹林联合氯吡格雷治疗短暂性脑缺血患者120例

目的观察阿司匹林联合氯吡格雷治疗短暂性脑缺血(Transient Ischemic Attack,TIA)患者临床疗效,评价其有效性和安全性。方法将我院收治的确诊为短暂性脑缺血患者患者120例,随机分为阿司匹林组,氯吡格雷组和联合用药组(阿司匹林+氯吡格雷),每组40例。阿司匹林组给予阿司匹林(国药准字h19980007)100mg/d;氯吡格雷组给予氯吡格雷(国药准字J20040006)75 mg/d;联合用药组给予阿司匹林75～100mg/d,氯吡格雷75 mg/d,1个月为1个疗程。结果三组患者患者症状、体征改善情况以及TIA再发率等显示,阿司匹林组与氯吡格雷组无明显差异(P>0.05),联合用药组优于单药组(阿司匹林组和氯吡格雷组)(P<0.05)。随访半年,3组患者出血等不良反应无明显差异(P<0.05)。结论阿司匹林联合氯吡格雷治疗短暂性脑缺血患者疗效确切,优于两种药单用,且不良反应发生率无明显增加。     

频发短暂性脑缺血发作的患者临床药物观察研究

目的:探讨针对应用双抗血小板(阿司匹林与氯吡格雷)治疗后仍频发的短暂性脑缺血发作(transient cerebral ischemia,TIA)联合阿托伐他汀治疗后的临床疗效.方法:采用随机数字法分为两组,对照组75例,应用阿司匹林100mg/d与氯吡格雷75mg/d治疗;观察组75例,在对照组基础上联合阿托伐他汀20mg/d维持治疗.结果:观察组(75例),完全控制未复发68例,总有效率为90.67％,无1例出血、横纹肌溶解等不良反应;对照组(75例),完全控制未复发55例,总有效率为73.33％,有14例发展为脑梗死.观察组总有效率明显高于对照组(P＜0.05).结论:双抗血小板联合阿托伐他汀控制频发TIA效果优于双抗血小板(阿司匹林与氯吡格雷)的治疗,降低TIA发作及进展成卒中的风险,治疗期未出现明显出血等不良反应,安全有效.     

硫酸氯吡格雷联合阿托伐他汀治疗短暂性脑缺血发作40例

目的 观察硫酸氯吡格雷联合阿托伐他汀胶囊治疗短暂性脑缺血发作（TIA）的近期疗效.方法 将80例TIA患者随机分为治疗组和对照组,各40例,均采用对症、病因治疗,治疗组加用硫酸氯吡格雷75 mg,阿托伐他汀胶囊1粒（20 mg）口服;对照组加用阿司匹林肠溶片100 mg口服,均每日1次,14 d为1个疗程,2个疗程内判断疗效.结果 治疗组显效29例（72.50％）,有效10例（25.00％）,无效l例（2.50％）;对照组显效13例（32.50％）,有效18例（45.00％）,无效9例（22.50）,治疗组显效率明显高于对照组（P＜0.01）.结论 硫酸氯吡格雷联合阿托伐他汀胶囊治疗TIA有效.     

不同剂量氯吡格雷联合阿司匹林治疗不稳定型心绞痛的临床研究

目的对不同剂量氯吡格雷联合阿司匹林治疗不稳定型心绞痛(UAP)的有效性和安全性进行评估。方法将80例不稳定型心绞痛患者随机分为观察组(氯吡格雷150 mg/d+阿司匹林l00 mg/d)和对照组(氯吡格雷75 mg/d+阿司匹林100 mg/d),治疗90 d,观察心绞痛缓解程度、心血管原因死亡、急性心肌梗死、心力衰竭、出血和血细胞异常发生的情况。结果心绞痛缓解有效率、心血管原因死亡、急性心肌梗死、心力衰竭发生等主要观察指标和终点事件方面并无显著性差异。但是,严重出血和血小板减少在氯吡格雷150 mg/d组明显增多,两组有统计学差异。结论氯吡格雷l50 mg/d联合阿司匹林100 mg/d治疗不稳定型心绞痛疗效与氯吡格雷75 mg/d相似,但安全性较差。     

阿托伐他汀联合氯吡格雷治疗短暂性脑缺血发作疗效观察

目的:观察阿托伐他汀联合氯吡格霄治疗短暂惟脑缺血发作(TIA)的临床疗效.方法:将136例患者随机分成治疗组和对照组,两组均给予阿司匹林100 mg/d及氯吡格雷150 mg/d口服,3 d后氯毗格雷减量为75 mg/d口服,在此基础上治疗组给予阿托伐他汀20 mg/d口服,于开始治疗后3 d、5 d、7 d观察TIA发作控制情况,于3、6、12个月随访脑梗死发生情况.结果:治疗组和对照组总有效率分别为84.28%和69.70%,组间比较差异有显著性,治疗组血脂有显著改变,对照组改变不明显.结论:阿托伐他汀联合氯吡格雷能够在短期内控制TIA发作,并通过调节血脂等作用而减少远期脑梗死的发生.     

氯吡格雷联合阿司匹林预防非心源性缺血性卒中的疗效观察

目的观察氯吡格雷联合阿司匹林肠溶片在非心源性缺血性卒中二级预防中的疗效和安全性。方法连续收集非心源性缺血性卒中患者并随机分为治疗组与对照组,每组55例患者,两组均给予卒中基础治疗。治疗组予硫酸氢氯吡格雷口服,75 mg/d,联合阿司匹林肠溶片口服100 mg/d,共30 d,30 d后改单用阿司匹林肠溶片口服100 mg/d。对照组单用阿司匹林肠溶片口服,100 mg/d。随访1年内两组缺血性卒中复发率和药物不良反应发生率。结果对照组卒中复发率为12.7%,而治疗组复发率为1.8%,差异有统计学意义(P=0.022);对照组组不良反应发生率为9.1%,治疗组不良反应发生率为10.9%,差异无统计学意义(P>0.05)。结论氯吡格雷联合阿司匹林在非心源性缺血性卒中二级预防中的疗效优于单用阿司匹林,安全性较高。     

氯吡格雷片预防缺血性脑血管病复发的综合效果研究

目的:探讨氯吡格雷片(波立维)在预防缺血性脑血管病复发方面的临床效果。方法:选择2010年7月—2012年3月治疗的132例缺血性脑血管病患者,随机分为氯吡格雷组和阿司匹林组。氯吡格雷组65例,在常规治疗基础上口服氯吡格雷片75 mg/d;阿司匹林组67例,在常规治疗基础上口服拜阿司匹林0.1 mg/d,随访12个月,记录并比较两组患者的健康状况以及不良反应。结果:氯吡格雷组患者缺血性脑血管病复发率显著低于阿司匹林组(P<0.05);氯吡格雷组用药期间不良反应发生率为12.31%,阿司匹林组为26.87%,两组间差异有统计学意义(P<0.05)。结论:氯吡格雷预防缺血性脑血管复发的临床效果优于阿司匹林,且安全性高。     

氯吡格雷联合阿司匹林治疗短暂性脑缺血发作疗效观察

目的观察氯吡格雷联合阿司匹林治疗短暂性脑缺血发作（TIA）的疗效及安全性。方法对比分析3组患者治疗3个月期间,TIA复发率、脑梗死发生率、并发症及不良反应。结果氯吡格雷联合阿司匹林应用组TIA复发率及脑梗死发生率,均明显低于单用氯吡格雷及单用阿司匹林组,未增加出血倾向,不良反应轻微。结论氯吡格雷联合阿司匹林治疗TIA效果明显,用药安全,可减少TIA发作,减少脑梗死的发生率。     

Current Management of Transient Ischemic Attack

Transient ischemic attack (TIA) is a precursor to ischemic stroke. At least half of patients with TIA have a new, small ischemic lesion demonstrable on magnetic resonance imaging using a diffusion weighted sequence. The risk of subsequent major stroke is 10-20% in the next 3 months with much of that risk front-loaded in the first week. Strategies to identify and treat high-risk patients need to be defined. The optimal treatment approach and the timing of interventions, both medical and surgical, remains unknown. In general, aspirin is the first line of treatment to prevent further stroke. Other antiplatelet agents such as clopidogrel alone or in combination with aspirin and the combination aspirin/extended-release dipyridamole may be administered. Endarterectomy or carotid stenting is of great benefit to patients with TIA secondary to stenosis in the extracranial carotid artery.     

Aspirin and esomeprazole are superior to clopidogrel in preventing recurrent ulcer bleeding

Although low-dose aspirin is commonly used as the antiplatelet agent to prevent ischaemic events such as myocardial infarction and stroke, clopidogrel is probably superior at preventing ischaemic events. For patients who cannot tolerate aspirin, adding a proton pump inhibitor or substituting clopidogrel are options. Patients with endoscopy-confirmed ulcer healing were assigned to clopidogrel 75 mg/day or aspirin 80 mg/day and esomeprazole 20 mg b.i.d. for 12 months. There were 14 confirmed cases of recurrent ulcer bleeding, with 13 being from the 161 patients taking clopidogrel and 1 from the 159 patients taking aspirin plus esomeprazole. This trial has clearly shown that the combination of aspirin and esomeprazole is superior to clopidogrel in preventing recurrent ulcer bleeding. A more interesting study may have been to compare the effects of aspirin and clopidogrel in the presence of esomeprazole in patients with a history of ulcers.     

Aspirin and esomeprazole are superior to clopidogrel in preventing recurrent ulcer bleeding

Although low-dose aspirin is commonly used as the antiplatelet agent to prevent ischaemic events such as myocardial infarction and stroke, clopidogrel is probably superior at preventing ischaemic events. For patients who cannot tolerate aspirin, adding a proton pump inhibitor or substituting clopidogrel are options. Patients with endoscopy-confirmed ulcer healing were assigned to clopidogrel 75 mg/day or aspirin 80 mg/day and esomeprazole 20 mg b.i.d. for 12 months. There were 14 confirmed cases of recurrent ulcer bleeding, with 13 being from the 161 patients taking clopidogrel and 1 from the 159 patients taking aspirin plus esomeprazole. This trial has clearly shown that the combination of aspirin and esomeprazole is superior to clopidogrel in preventing recurrent ulcer bleeding. A more interesting study may have been to compare the effects of aspirin and clopidogrel in the presence of esomeprazole in patients with a history of ulcers.     

P2Y1、P2Y12和ITGB3基因多态性对PCI术后氯吡格雷抗血小板效应的影响

目的:观察P2Y1、P2Y12和ITGB3基因多态性对经皮冠状动脉介入(PCI)术后氯吡格雷抗血小板效应的影响。方法:520例冠心病患者行PCI术前给予硫酸氢氯吡格雷负荷剂量300 mg/d,口服+阿司匹林负荷剂量100 mg/d,口服;术后给予硫酸氢氯吡格雷维持剂量75 mg/d,口服,服用6个月以上+阿司匹林维持剂量100 mg/d,口服,服用1年,如患者出现胃出血等不宜服用时停止用药。观察患者一般资料、基因分型、P2Y1单体型与主要不良心血管事件(MACE)、出血事件的关联性。结果:520例患者中约82%为男性,40%为吸烟者;老年、合并高血压或合并糖尿病时MACE发生风险相对较高,风险比(HR,95%CI)分别为1.03(1.00,1.06)、3.15(1.46,6.78)和2.78(1.51,5.10);合并糖尿病可增加出血风险,服用血管紧张素转换酶(ACE)抑制剂可减少出血风险,比值比(OR,95%CI)分别为1.94(1.14,3.33)和0.51(0.30,0.84);P2Y12 c.-15+742C>T、P2Y1 c.57C>T、P2Y1 c.786A>G不同基因型及P2Y1不同单体型患者PCI术后MACE及出血事件比较,差异均无统计学意义(P>0.05)。ITGB3因最小等位基因频率较小,未作统计学分析。结论:P2Y1、P2Y12和ITGB3基因型不能作为冠心病患者临床终点事件和出血事件发生风险的标记物。     

Ticagrelor. Acute coronary syndromes: nothing new

Several revascularisation methods are effective in patients with acute coronary syndromes. Standard antithrombotic treatment combines heparin and aspirin during the acute phase, followed by long-term aspirin therapy. The only proven advantage of adding clopidogrel is for patients who undergo angioplasty with stenting. Ticagrelor is an antiplatelet drug belonging to a different chemical class than clopidogrel. Its chemical structure resembles that of adenosine. Ticagrelor has been authorised in the European Union for patients with acute coronary syndromes, in combination with aspirin. Clinical evaluation is mainly based on a double-blind randomised trial comparing ticagrelor + aspirin versus clopidogrel + aspirin in 18 624 patients who underwent angioplasty (64% of patients), coronary artery bypass grafting (10%), or who received medical treatment only. Half of the patients were treated for at least 9 months. After 12 months of treatment, compared to the clopidogrel group, overall mortality appeared to be significantly lower in the ticagrelor group (4.5% versus 5.9%), along with cardiovascular mortality (4.0% versus 5.1%). Symptomatic myocardial infarction was also less frequent (5.8% versus 6.9%), but not stroke (about 1.4% in both groups). Ticagrelor did not statistically significantly reduce overall mortality in patients who had angioplasty with stenting, but stent thrombosis was less frequent than with clopidogrel (2.9% versus 3.8%). In combination with aspirin, ticagrelor provoked more bleeding than clopidogrel, based on the definition used in the trial (16.1% versus 14.6%). In contrast, the rate of major bleeding was similar in the two groups (11.5%), including fatal bleeding (0.3%). The adverse effect profile of ticagrelor resembles that of adenosine in certain respects. For example, dyspnoea was more frequent with ticagrelor than with clopidogrel (13.8% versus 7.8%), as were conduction disorders and ventricular pauses at the beginning of treatment (5.8% versus 3.6%). There were also more cases of hyperuricaemia and elevated creatinine levels with ticagrelor. Ticagrelor and its active metabolite are substrates and inhibitors of cytochrome P450 isoenzymes and P-glycoprotein, creating a risk of multiple pharmacokinetic interactions. Pharmacodynamic interactions are also likely to occur, especially with antithrombotic agents and heart-rate-lowering drugs. In practice, in patients with an acute coronary syndrome treated with angioplasty and stenting, and who are also receiving aspirin, it remains to be shown whether the harm-benefit balance of ticagrelor is clearly better than that of clopidogrel. In other settings, there is no firm evidence that ticagrelor is better than aspirin alone.     

双负荷剂量氯吡格雷联合阿司匹林治疗脑梗死的疗效及安全性

目的 探究双负荷剂量氯吡格雷联合阿司匹林治疗脑梗死的效果及用药安全性.方法 选取2013年7月至2015年7月收治的90例脑梗死患者为观察对象,按照随机数字表法将患者分为标准剂量组和双负荷剂量组,每组45例.标准剂量组患者给予氯吡格雷75 mg/d+阿司匹林100 mg/d治疗,双负荷剂量组患者给予第1天口服氯吡格雷300 mg+阿司匹林300 mg,以后服用氯吡格雷75 mg/d+阿司匹林100 mg/d治疗.连续治疗8周,对比两组疗效及药物副作用.结果 双负荷剂量组患者疗效明显高于标准剂量组(97.78％ vs.84.44％;Z=7.717,P=0.042).两组患者药物不良反应发生率差异无统计学意义(P＞0.05).结论 双负荷剂量氯吡格雷联合阿司匹林治疗能够有效改善脑梗死患者临床症状,具有安全高效和副作用少等特点,值得在脑梗死治疗中推广应用.     

低白蛋白血症、高龄对同时服用阿托伐他汀、氯吡格雷、阿司匹林患者出血性事件的影响

目的探讨低白蛋白血症、年龄对同时服用阿托伐他汀、氯吡格雷、阿司匹林患者出血性事件的影响。方法选取2016年1月至2018年5月在某院因冠状动脉狭窄行冠脉造影或支架植入术同时使用了阿托伐他汀20 mg、氯吡格雷75 mg、阿司匹林100 mg的患者。研究血中白蛋白含量的影响时,将患者分为低白蛋白(≤35 g/L)组和正常白蛋白(>35 g/L)组;研究年龄的影响时,将患者分为≥70岁组和<70岁组,统计两组中尿潜血、大便隐血、血红蛋白出现影响的例数并比较其差异,使用χ~2检验比较分类变量。以有无出血为因变量,年龄、性别、入院时收缩压、心率、红细胞压积、内生肌酐清除率、血中白蛋白含量、有无糖尿病、有无周围血管和脑血管病变作自变量,使用二项logistic回归分析评价低蛋白血症及其他常见出血因素引起出血的风险。结果低白蛋白组和正常白蛋白组服药后尿潜血、大便隐血转为阳性的发生率存在差异,用药后血红蛋白下降大于10 g/L,且低于正常值的发生率存在显著差异。≥70岁组和<70岁组服药后尿潜血转为阳性的发生率存在显著性差异;服药后大便隐血转为阳性的发生率高龄组大于低龄组,但无显著性差异;用药后血红蛋白下降大于10 g/L,且低于正常值的发生率存在显著差异。多因素logistic回归分析显示高龄、女性、低白蛋白均可增加该类患者的出血风险。结论同时使用阿托伐他汀、氯吡格雷、阿司匹林的患者,低白蛋白及高龄增加了出血概率。     

颈部血管彩色超声及磁共振血管造影术对缺血性脑血管病的诊断价值

目的评价颈部血管彩色超声及磁共振血管造影术(MRA)对缺血性脑血管病的诊断价值,并探讨颈动脉粥样硬化与缺血性脑血管病及其他危险因素的关系。方法以80例脑血栓形成患者、30例一过性缺血发作(TIA)患者为病例组,40例非心脑血管病患者为对照组,行颈动脉超声检测颈动脉粥样硬化程度,部分病例行MRA检查。结果颈动脉粥样硬化斑块发生率在脑血栓形成组、TIA组及对照组分别为59%、50%和22%。脑血栓形成组斑块发生率与对照组相比差异有统计学意义(P<0.01);软斑检出率在脑血栓形成组、TIA组及对照组分别为68%、53%和10%,脑血栓形成组软斑检出率与对照组相比差异有统计学意义(P<0.01)。脑血栓形成组内-中膜厚度(IMT)增厚与对照组相比差异有统计学意义(P<0.01)。斑块常见于颈总动脉近分叉处,且易发生在双侧颈动脉及与脑部病灶同侧的颈动脉,40例患者行颈动脉超声及MRA检查,两者对颈内动脉闭塞的吻合率为100%,轻度狭窄的吻合率为75%,中重度狭窄的吻合率为80%。Logistic回归分析确定的颈动脉粥样硬化的危险因素是高血压。结论颈部血管彩色超声对于预测缺血性脑血管病具有重要意义,应定期对高危人群进行颈部血管彩色超声检查,因MRA检查费用高而无法成为常规检查项目。     

动脉支架成形术治疗颈动脉粥样硬化性狭窄

目的：分析颈动脉支架成行术治疗颈动脉粥样硬化性狭窄的效果。方法：15例症状性颈动脉狭窄患者,在血栓保护伞保护下,置入颈动脉支架,并以球囊扩张狭窄部位。结果：所有患者成功置入支架,术后出现同侧脑梗塞1例,穿刺点皮下血肿3例,颈动脉夹层1例,血管痉挛2例,分别通过手术或药物治愈。随访3～15月,TIA减少3例,对侧脑梗塞1例,其余患者TIA消失,语言及肢体活动改善。结论：血管内支架成行术治疗颈内动脉粥样硬化性狭窄．配合血栓保护伞使用,操作安全．效果明显,值得临床应用。     

The antithrombotic effect of melagatran in combination with clopidogrel and/or aspirin (carotid artery primary thrombosis study)

Melagatran with aspirin and/or clopidogrel was evaluated for prevention of arterial thrombosis in a model of vessel wall injury. Thirty-five dogs were randomized to receive placebo (n=14), aspirin (7 to 8 mg/kg, p.o. q12 h for three doses with the last dose administered 12 hours before surgery, n=7), clopidogrel (1 mg/kg p.o. QDx3, n=7), or aspirin+clopidogrel (n=7). The right carotid artery (RCA) was the control vessel, whereas the left carotid artery (LCA) was subjected to injury after administration of Melagatran (0.033 mg/kg i.v.+0.1 mg/kg/h). Clopidogrel, but not aspirin pretreatment, increased time (135.6+/-13.5 vs. 116.1+/-27.8 minutes) to RCA thrombosis versus placebo (88.1+/-10.5 minutes). Melagatran prolonged time to occlusion (min) in the LCA (192.4+/-10.9) versus the placebo-treated RCA (88.1+/-10.5). Addition of Melagatran plus aspirin or clopidogrel prevented formation of occlusive thrombosis, in all LCAs. A two-fold increase in tongue bleeding time was observed after aspirin+Melagatran (178.6+/-14.7 to 347.1+/-87.3 seconds) or clopidogrel+Melagatran (279.9+/-97.3 to 437.1+/-142.5 seconds). However, the combination of aspirin and clopidogrel prevented occlusive thrombosis in the RCA and the subsequent addition of Melagatran did not further increase bleeding time. The combination of Melagatran+aspirin or clopidogrel can reduce formation of occlusive arterial thrombosis without eliciting a significant increase in bleeding-time.