王钰;庄铨坤;朱晓洁;王珺;白汉生;张予阳;

• 1:沈阳药科大学生命科学与生物制药学院

摘要(Abstract)：

目的以阿司匹林为对照组,系统评价阿司匹林双嘧达莫联合用药,对缺血性脑卒中二级预防的有效性和安全性。方法通过卒中、非致死性卒中、各种原因引起的死亡及非致死性卒中与各种原因引起的死亡联合事件发生的相对危险度,分析联合用药的有效性,通过出血性并发症及脑出血发生的相对危险度,分析联合用药的安全性。结果 a.与阿司匹林相比较,联合用药能更有效的预防卒中的发生(RR=0.86 95%CI[0.74,1.00]),使非致死性卒中的发生率降低22%(RR=0.78 95%CI[0.67,0.90]),也能明显降低非致死性卒中与各种原因引起的死亡联合事件的发生率(RR=0.87 95%CI[0.79,0.96])。但是,联合用药对各种原因引起的死亡无效(RR=0.98,95%CI[0.85,1.13])。b.与阿司匹林相比较,联合用药不会增加出血性并发症的发生率(RR=0.95,95%CI[0.80,1.12]),但可以使脑出血的发生率增加14%(RR=1.14,95%CI[0.54,2.42]),尽管这一结果无明显统计学意义。结论与阿司匹林相比较,联合用药对卒中、非致死性卒中及非致死性卒中与各种原因引起的死亡联合事件的预防更有效,联合用药不会增加出血性并发症的发生率,但能轻微增加脑出血的发生率。

关键词(KeyWords)： 阿司匹林;双嘧达莫;缺血性卒中;二级预防

Abstract:

Keywords:

基金项目(Foundation):

作者(Authors): 王钰;庄铨坤;朱晓洁;王珺;白汉生;张予阳;

DOI: 10.14066/j.cnki.cn21-1349/r.2013.08.009

参考文献(References)：

• [1]RAJU M,MOOD G,LAIRD-FICK H,et al.Cerebro-vascular steal phenomenon in a patient undergingdipyridamole nuclear perfusion cardiac imaging[J].JC Cases,2012,5(2):e125-e127.
• [2]DIENER H C,CUNHA L,FORBES C,et al.Europe-an Stroke Prevention Study 2:dipyridamole and acety-lsalicylic acid in the secondary prevention of stroke[J].J Neurol Sci,1996,143(1/2):1-13.
• [3]FURIE K L,KASNER S E,ADAMS R J,et al.Guidelines for the prevention of stroke in patients withstroke or transient ischemic attack:a guideline forhealthcare professionals from the American heart asso-cia-tion/American stroke association[J].Stroke,2011,42(1):227-276.
• [4]BLL AD,ROUSSIN A,CARTIER R,et al.The use ofantiplatelet therapy in the outpatient setting:Canadiancardiovascular society guidelines executive summary[J].Can J Cardiol,2011,27(2):208-221.
• [5]UCHIVAMA S,IKEDA Y,URANO Y,et al.The Jap-anese aggrenox(extended-release dipyridamole plusaspirin)stroke prevention versus aspirin programme(JASAP)study:a randomized,double-blind,con-trolled trial[J].Cerebrovasc Dis,2011,31(6):601-613.
• [6]BOUSSER M G,ESCHWEGE E,HAGUENAU M,etal.“AICLA”controlled trial of aspirin and dipyri-damole in the secondary prevention of atherothrom boticcerebral ischemia[J].Stroke,1983,14(1):5-14.
• [7]HOSP L G,TONNARELLI PIAZZA I,et al.Persan-tine aspirin trial in cerebral ischemia,part II:endpointresults[J].Stroke,1985,16(3):406-415.
• [8]HAIKES P H,GIJN J V,KAPPELLE L J,et al.Aspi-rin plus dipyridamole versus aspirin alone after cere-bral ischaemia of arterial origin(ESPRIT):random-ized controlled trial[J].Lancet,2006,367(9523):1665-1673.
• [9]HUANG E S,STRATE L L,HO W W,et al.Long-term use of aspirin and the risk of gastrointestinalbleeding[J].Am J Med,2011,124(5):426-433.
• [10]LANAS A,WU Ping,MEDIN J,et al.Low doses ofacetyls-alicylic acid increase risk of gastrointestinalbleeding in a meta-analysis[J].Clin GastroenterolHepatol,2011,9(3):762-768.
• [11]CAYLA G,COLLET J P,SILVAIN J,et al.Preva-lence and clinical impact of upper gastrointestinalsymptoms in subjects treated with low dose aspirin:The UGLA survey[J].Int J Cardiol,2012,156(1):69-75.
• [12]JOHNSON E S,LANES S F,WENTWORTH III CE,et al.A metaregression analysis of the dose-re-sponse effect of aspirin on strok[J].Arch InternMed,1999,159(11):1248-1253.
• [13]HALKES P H A,GRAY L J,BATH P M W,et al.Dipyridamole plus aspirin versus aspirin alone in thesecondary prevention after TIA or stroke:a meta anal-ysis by risk[J].J Neurol Neurosurg Psychiatry,2008,79(11):1218-1223.
• [14]VERRO P,GORELICK P B,NGUYEN D.Aspirinplus dipyridamole versus aspirin for prevention of vas-cular events after stroke or TIA:a meta-analysis[J].Stroke,2008,39(4):1358-1363.
• [15]DERENDORF H,VANDERMAELEN C P,BRIEKLR S,et al.Dipyridamole bioavailability in subjectswith reduced gastric acidity[J].J Clin Pharmacol,2005,45(7):845-850.