氯吡格雷在短暂性脑缺血发作后脑卒中二级预防中的应用

目的探讨氯吡格雷在短暂性脑缺血发作(transient ischemic attack,TIA)后预防缺血性脑卒中发作的疗效。方法选择TIA患者279例,随机分为2组:氯吡格雷组158例(氯吡格雷75 mg,1次/d),长效阿司匹林组121例(拜阿司匹林100 mg,1次/d)。患者随访1.5～3.0(2.3±0.3)年,评估2组的安全性。结果氯吡格雷组患者缺血性脑卒中复发率明显低于长效阿司匹林组,差异有统计学意义(5.06% vs 12.40%,P0.05)。全部患者在TIA后缺血性脑卒中复发的危险比为0.4031,氯吡格雷组为0.1284,长效阿司匹林组为0.8129,差异有统计学意义(P0.05)。氯吡格雷组患者发生次要事件概率和胃肠道出血事件明显低于长效阿司匹林组,差异有统计学意义(1.90% vs 8.26%,1.27% vs 6.61%,P0.05)。结论氯吡格雷对TIA患者的缺血性脑卒中的预防,优于长效阿司匹林。

Use of clopidogrel for secondary prevention of stroke after transient ischemic attack

Objective To evaluate the efficacy of clopidogrel in secondary prevention of ischemic stroke after transient ischemic attack (TIA).Methods 279 patients with TIA were divided into two groups at random; 158 patients were assigned to clopidogrel group(clopidogrel 75 mg,1 time/ d).121 patients were assigned to long-acting aspirin groupCaspirin 100 mg,l time/d).The safety of treatment in two groups was assessed.All patients were followed up for 1.5～3.0(2.3±0.3) years.Results The rate of developing ischemic stroke after TIA was significantly lower in the clopidogrel group than in the long-acting aspirin group(5.06% vs 12.40%,P < 0.05).The risk ratio of ischemic stroke was 0.4031 in all patients after TIA.In the clopidogrel group and the long-acting aspirin group,the risk ratio of ischemic stroke was 0.1284 and 0.8129,respectivity, the difference between the two groups was statistically significant (P < 0.05).Rate of minor events was significantly lower in the clopidogrel group than in the aspirin group (1.90% vs 8.26% ,x~2=4.756,P< 0.05).Adverse side-effects showed that rate of gastrointestinal bleeding was significantly lower in clopidogrel group than in aspirin group(1.27% vs 6.61%,x~2= 4.225, P <0.05).Conclusions Clopidogrel is more effective than aspirin in prevention of ischaemic stroke in patients with TIA.