Low-dose and high-dose acetylsalicylic acid for patients undergoing carotid endarterectomy: a randomised controlled trial. ASA and Carotid Endarterectomy (ACE) Trial Collaborators.
Low-dose and high-dose acetylsalicylic acid for patients undergoing carotid endarterectomy: a randomised controlled trial. ASA and Carotid Endarterectomy (ACE) Trial Collaborators.
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低剂量和高剂量乙酰水杨酸用于接受颈动脉内膜切除术的患者：一项随机对照试验。
DOI：
10.1016/s0140-6736(99)05388-x
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发表时间：
1999
期刊：
影响因子：
--
通讯作者：
Spence,JD
中科院分区：
文献类型：
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作者：
Taylor,DW;Barnett,HJ;Haynes,RB;Ferguson,GG;Sackett,DL;Thorpe,KE;Simard,D;Silver,FL;Hachinski,V;Clagett,GP;Barnes,R;Spence,JD
背景动脉内膜切除术对某些颈动脉狭窄患者有益，但围手术期手术风险会降低获益。乙酰水杨酸可降低经历过短暂性脑缺血发作和中风的患者中风的风险。我们研究了乙酰水杨酸在接受颈动脉内膜切除术的患者中的适当剂量和作用。方法在一项随机、双盲、对照试验中，2849 名计划接受动脉内膜切除术的患者被随机分配服用 81 毫克 (n=709)、325 毫克 (n=708)、650 毫克 (n=715) 或 1300 毫克 (n=717) 乙酰水杨酸每天服用酸，在手术前开始并持续 3 个月。我们记录了中风、心肌梗塞和死亡的发生情况。我们将服用两种较高剂量乙酰水杨酸的患者与服用两种较低剂量乙酰水杨酸的患者进行了比较。结果 45 名患者取消了手术，无一例失访 30 天，两名患者失访 3 个月。 30天时（5·4 vs 7·0%，p=0·07）和3个月时（6·2 vs 8·4%，p=0·03），低剂量组的卒中、心肌梗死和死亡综合发生率低于高剂量组。在一项功效分析中，排除了随机分组前服用 650 mg 或更多乙酰水杨酸的患者以及手术后 1 天内随机分组的患者，30 天时的综合发生率分别为 3·7% 和 8·2% (p=0·002)，3 个月时的综合发生率分别为 4·2% 和 10·0% (p=0·0002)。每天服用 81 mg 或 325 mg 乙酰水杨酸的患者比服用 650 mg 或 1300 mg 的患者的 3 个月动脉内膜切除术要短。
BackgroundEndarterectomy benefits certain patients with carotid stenosis, but benefits are lessened by perioperative surgical risk. Acetylsalicylic acid lowers the risk of stroke in patients who have experienced transient ischaemic attack and stroke. We investigated appropriate doses and the role of acetylsalicylic acid in patients undergoing carotid endarterectomy.MethodsIn a randomised, double-blind, controlled trial, 2849 patients scheduled for endarterectomy were randomly assigned 81 mg (n=709), 325 mg (n=708), 650 mg (n=715), or 1300 mg (n=717) acetylsalicylic acid daily, started before surgery and continued for 3 months. We recorded occurrences of stroke, myocardial infarction, and death. We compared patients on the two higher doses of acetylsalicylic acid with patients on the two lower doses.FindingsSurgery was cancelled in 45 patients, none were lost to follow-up by 30 days, and two were lost by 3 months. The combined rate of stroke, myocardial infarction, and death was lower in the low-dose groups than in the high-dose groups at 30 days (5·4 vs 7·0%, p=0·07) and at 3 months (6·2 vs 8·4%, p=0·03). In an efficacy analysis, which excluded patients taking 650 mg or more acetylsalicylic acid before randomisation, and patients randomised within 1 day of surgery, combined rates were 3·7% and 8·2%, respectively, at 30 days (p=0·002) and 4·2% and 10·0% at 3 months (p=0·0002).InterpretationThe risk of stroke, myocardial infarction, and death within 30 days and 3 months of endarterectomy is lower for patients taking 81 mg or 325 mg acetylsalicylic acid daily than for those taking 650 mg or 1300 mg.