Effect of Antiplatelet Therapy (Aspirin plus Dipyridamole Versus Clopidogrel) on Mortality Outcome in Ischemic Stroke
Effect of Antiplatelet Therapy (Aspirin plus Dipyridamole Versus Clopidogrel) on Mortality Outcome in Ischemic Stroke
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DOI：
10.1016/j.amjcard.2018.05.043
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发表时间：
2018-09-15
影响因子：
2.8
通讯作者：
Myint, Phyo K.
中科院分区：
文献类型：
--
作者：
Barlas, Raphae S.;Loke, Yoon K.;Myint, Phyo K.
非心源性缺血性卒中二级预防的最佳抗血小板治疗方案仍存在争议。我们的目的是确定哪种方案与最大程度地减少不良后果相关。我们分析了从诺福克和诺维奇大学医院中风登记处收集的前瞻性数据。样本人群包括3,572名缺血性卒中患者（平均年龄74.96±12.67岁），他们在2003年至2015年期间连续入院。患者出院时接受三种抗血小板方案中的一种；阿司匹林单药治疗，阿司匹林加双嘧达莫和氯吡格雷。氯吡格雷和阿司匹林加双嘧达莫与阿司匹林比较。氯吡格雷与阿司匹林加双嘧达莫的直接比较也进行了。结果包括全因死亡率和全因死亡率和主要不良心脏事件（中风或心肌梗死）发生率的联合终点。在出院后的以下时间段调整了潜在混杂因素的Cox回归模型；0 ~ 90天，91 ~ 365天，1 ~ 3年。阿司匹林加双嘧达莫与0 ~ 90天死亡风险较低相关；风险比（HR） 0.62（0.43 ~ 0.91）。氯吡格雷与1 - 3年死亡风险较低相关；HR为0.39（0.26 ~ 0.60）。在综合结果的相应时间点观察到相似的hr。总之，非心源性卒中患者最初可从阿司匹林联合双嘧达莫中获得最大益处(
The optimal regimen of antiplatelet therapy for secondary prevention in noncardioembolic ischemic stroke remains controversial. We aimed to determine which regimen was associated with the greatest reduction in adverse outcomes. We analysed prospectively collected data from the Norfolk and Norwich University Hospital Stroke Register. The sample population consisted of 3,572 participants (mean age 74.96 +/- 12.67) with ischemic stroke, who were consecutively admitted between 2003 and 2015. Patients were placed on one of three antiplatelet regimens at hospital discharge; aspirin monotherapy, aspirin plus dipyridamole and clopidogrel. Clopidogrel and aspirin plus dipyridamole were compared to aspirin. A direct comparison between clopidogrel and aspirin plus dipyridamole was also performed. Outcomes included all-cause mortality and a combined end point of all-cause mortality and incidence of major adverse cardiac events (stroke or myocardial infarction). Cox regression models adjusted for potential confounders at the following time periods after discharge; 0 to 90 days, 91 to 365 days, and 1 to 3 years. Aspirin plus dipyridamole was associated with a lower risk of mortality at 0 to 90 days; hazard ratio (HR) 0.62 (0.43 to 0.91). Clopidogrel was associated with a lower risk of mortality at 1 to 3 years; HR of 0.39 (0.26 to 0.60). Similar HRs were observed for the corresponding time points in the composite outcome. In conclusion, patients with noncardioembolic stroke may gain maximum benefits from aspirin plus dipyridamole initially (