抗血小板药物联合治疗在缺血性脑血管病中的应用

Combination antiplatelet agents in ischemic cerebrovascular disease

抗血小板药物具有不同的作用机制,用于治疗频发性动脉疾病,包括脑血管疾病。近期的脑血管及心血管试验表明,联合治疗可以有效的预防缺血性脑血管病。预防血栓形成的药物氯吡格雷,曾被誉为超级阿斯匹林,与阿斯匹林联合治疗脑缺血显示出比单独使用阿斯匹林更突出的功效。阿斯匹林与防治心绞痛控释药双嘧达莫联合治疗效果较为突出。尽管如此,缺血性脑血管病的抗血小板药物联合治疗仍然存在着某些争议。目前的研究旨在区分不同抗血小板联合剂的作用。

Antiplatelet agents with multiple mechanisms of action are being used with increasing frequency for vascular disorders, including cerebrovascular disease. Over the last few years, several cerebrovascular and cardiovascular trials have provided some preliminary information on the effectiveness of various combination therapies in preventing cerebral ischemic disease. This article reviews recently completed cerebrovascular and cardiovascular trials that tested a combination antiplatelet regimen against aspirin alone, and that assessed cerebral ischemia as an outcome measure. Based on cardiovascular studies, clopidogrel in combination with aspirin has been proven superior to aspirin alone for the primary prevention of cerebral ischemia. The combination of aspirin plus extended-release dipyridamole （xrDP） appears to be superior to aspirin alone in the secondary prevention of cerebral ischemia. Controversy abounds regarding the most effective antiplatelet regimen available for the prevention of Ischemic Cerebrovascular Disease. Ongoing trials are expected to clarify the role of various combination antiplatelet regimens.