急性缺血性卒中/短暂性脑缺血发作的早期抗血小板治疗研究进展

发病后48 h内使用阿司匹林是急性缺血性卒中除溶栓以外被循证医学证实惟一有效的治疗手段,但阿司匹林的净效益有限。国际上一直在开展替代阿司匹林的抗血小板药物或方案。糖蛋白IIb/IIIa受体拮抗剂治疗急性缺血性卒中的临床研究以失败而告终。阿司匹林联合双嘧达莫缓释剂、西洛他唑已经获得了至少与阿司匹林同样有效和安全的初步证据。氯吡格雷单用虽然获得了初步可行性的证据,但尚缺乏与阿司匹林的直接比较研究。短暂性脑缺血发作后抗血小板治疗或抗凝治疗是重要的二级预防手段,近年研究提示尽早实施则可以额外获益。而针对小卒中或TIA患者短期联合使用阿司匹林和氯吡格雷也获得了初步证据。本文对上述有关临床研究进行总结,结合国内外指南,系统阐述急性缺血性卒中和短暂性脑缺血发作患者早期抗血小板药物的规范化使用和发展方向。

Advances in early anti-platelet therapy in patients with ischemic stroke and transient ischemic attack

In addition to thrombolysis,use of aspirin within 48h after the onset is the only effective method to treat patients with acute ischemic stroke(AIS).However,the net benefit of aspirin is small.In the past decade,randomized clinical trials using other anti-platelet drugs to treat patients with AIS were performed.Among them,glycoprotein IIb/IIIa receptor antagonists failed to show any benefit for AIS;aspirin plus extended-release dipyridamole,cilostazol were proved at least as safe and effective as aspirin al...