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阿司匹林联合两种抗血小板药物对症状性脑动脉粥样硬化性狭窄患者

时间:2011-08-31 13:30来源:卒中网 作者:admin 点击:

  ——ASA+西洛他唑 vs. ASA+氯吡格雷治疗ICAS疗效相当

 

 

症状性脑动脉粥样硬化性狭窄(ICAS)的最佳治疗方案尚未确立。为此,韩国Asan医学中心开展一项研究,在与临床卒中复发相关的ICAS治疗中,比较阿司匹林+西洛他唑(西洛他唑组)和阿司匹林+氯吡格雷(氯吡格雷组)两种组合的疗效。试验结果表明,阿司匹林的这两种抗血小板治疗组合在预防ICAS和新缺血性病变形成中,没有显著性差异。(STROKEAHA.110.609370  Published online before print July 28, 2011,)

 

   该研究入选457例急性症状性脑动脉硬化狭窄患者随机分配到两组(西洛他唑组232例,氯吡格雷组225例),治疗7周后,主要终点是治疗ICAS过程中比较基线MR血管造影的狭窄,次要终点包括MRI中新的缺血性病变、复合性心血管事件的发生及大出血等并发症。

 

   研究结果显示,西洛他唑组心血管事件发生15例(6.4%),氯吡格雷组10例(4.4%)(P= 0.312)。西洛他唑组和氯吡格雷组均没有显著没有减少症状性ICAS的进展(分别为20/202,32/207比值比为0.61,P= 0.092)。新的缺血性病变(18.7%和12.0%,P= 0.078)和主要出血并发症(0.9%和2.6%,P=0.163)显示两组治疗结果无显著性差异。

 

Efficacy and Safety of Combination Antiplatelet Therapies in Patients With Symptomatic Intracranial Atherosclerotic Stenosis

Background and Purpose—An optimal strategy for management of symptomatic intracranial atherosclerotic stenosis (ICAS) has not yet been established. We compared the efficacy of 2 combinations of antiplatelets, aspirin plus cilostazol (cilostazol group) verus aspirin plus clopidogrel (clopidogrel group), on the progression of ICAS, which is known to be associated with clinical stroke recurrence.

Methods—In this investigator-initiated double-blind trial, 457 patients with acute symptomatic stenosis in the M1 segment of the middle cerebral artery or the basilar artery were randomly allocated into either a cilostazol group or a clopidogrel group. After 7 months of treatment, follow-up MR angiogram and MRI were performed. The primary end point was the progression of ICAS in comparison with stenosis on the baseline MR angiogram. Secondary end points included the occurrence of new ischemic lesions on MRI, composite of cardiovascular events, and major bleeding complications.

Results—Cardiovascular events occurred in 15 of 232 patients (6.4%) in the cilostazol group and 10 of 225 (4.4%) in the clopidogrel group (P=0.312). Cilostazol did not reduce the progression of symptomatic ICAS (20 of 202) compared to clopidogrel (32 of 207) (odds ratio, 0.61; P=0.092), although favorable changes in serum lipoproteins were observed in the cilostazol group. There were no significant differences between the 2 groups with respect to new ischemic lesions (18.7% versus 12.0%; P=0.078) and major hemorrhagic complications (0.9% versus 2.6%; P=0.163).

Conclusions—This trial failed to show significant difference in preventing progression of ICAS and new ischemic lesions between the 2 combination antiplatelet therapies in the patients with symptomatic ICAS.

Conclusions—This trial failed to show significant difference in preventing progression of ICAS and new ischemic lesions between the 2 combination antiplatelet therapies in the patients with symptomatic ICAS.
 

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