急性缺血性卒中的抗血小板治疗

Antiplatelet Therapy for Acute Ischaemic Stroke

急性缺血性卒中患者血小板被激活,抗血小板治疗可减少早期脑梗死的复发,减轻脑损伤的体积,降低早期死亡和改善存活者的长期预后。但抗血小板治疗增加非致死性或症状性颅内出血的发生率。阿司匹林是证据最充分且得到各国指南推荐的治疗急性缺血性卒中的抗血小板药物,对未溶栓治疗的急性缺血性卒中患者应尽早开始阿司匹林治疗。氯吡格雷、血小板糖蛋白Ⅱb/Ⅲa受体抑制剂、双嘧达莫、西洛他唑等单药用于治疗急性缺血性卒中的安全性和疗效目前尚无足够的证据。抗血小板药物联合应用的疗效和可能的风险尚需进一步研究。

In patients with acute ischaemic stroke (AIS),platelets become activated. Antiplatelet therapy can reduce the risk of early recurrent ischaemic stroke and reduce the volume of brain damaged. This might reduce the risk of early death and improve long-term outcome in survivors. However,antiplatelet therapy might also increase the risk of non-fatal or symptomatic intracranial haemorrhage. Aspirin was the most common used antiplatelet agent with more evidence and that was recommended by current stroke therapy guidelines in different countries. For patients with AIS who are not receiving thrombolysis,early aspirin therapy(150 to 300 mg/d) was recommended. There was no sufficient evidence about the safety and efficacy of administration of clopidogrel,glycoprotein (GP) Ⅱb/Ⅲa inhibitors,dipyridamole,cilostazol for the treatment of patients with AIS. The safety and efficacy of administration of combined antiplatelet agents for AIS need to be further studied.