阿司匹林联合氯吡格雷对中重度椎动脉起始部狭窄患者脑卒中二级预防的作用

Role of Aspirin with Clopidogrel in secondary prevention of stroke in moderate and severe stenosis of vertebral artery origin

摘要:

目的  探讨阿司匹林联合氯吡格雷在中重度椎动脉起始部狭窄（VAOS）患者脑卒中二级预防的作用。方法  将94例中重度VAOS患者分为双抗组和单抗组，联合服用阿司匹林和氯吡格雷者归入双抗组（50例），单用两者之一者归入单抗组（44例）。收集两组患者的基线资料并随访出院后1年的改良RanKin评分、美国国立卫生研究院卒中量表评分、卒中复发、预后不良及死亡等事件发生情况。结果  双抗组的预后不良率和卒中复发率分别为4.0%和2.0%，低于单抗组的13.6%和18.2%，差异有统计学意义（P <0.05），但两组间的死亡率比较差异无统计学意义（P >0.05）。双抗组出血发生率为8.0%，单抗组为6.8%，两组比较差异无统计学意义（P >0.05）。结论  阿司匹林联合氯吡格雷的能降低中重度的VAOS患者卒中复发率及预后不良率，且不增加出血的风险。

Abstract:

Objective To explore the role of Aspirin with Clopidogrel in secondary prevention of stroke in moderate and severe vertebral artery origin stenosis (VAOS). Methods Ninety-four cases of moderate and severe vertebral artery origin stenosis were divided into double antiplatelet group (n = 50, receiving combined Aspirin with Clopidogrel) and mono antiplatelet group (n = 44, receiving Aspirin or Clopidogrel alone). The mRS score, the NIHHS score and recurrent stroke, poor prognosis and death number were collected. Results The rates of poor prognosis and recurrent stroke in the double antiplatelet group were 4.0% and 2.0% respectively, which were significantly lower than those in the mono antiplatelet group (13.6% and 18.2% respectively, P < 0.05). There was no statistical difference in the mortality or hemorrhage rate between both groups (P > 0.05). Conclusions A combination of Aspirin and Clopidogrel is more effective and safer than Aspirin or Clopidogrel alone in secondary prevention of stroke in moderate and severe vertebral artery origin stenosis.