抗血小板治疗在缺血性脑卒中预防中的应用

Antiplatelet therapy in prevention of ischemic stroke

抗血小板治疗是缺血性脑卒中(IS)一级和二级预防的重要组成部分,未接受溶栓治疗的急性IS患者应尽早开始阿司匹林治疗。噻吩吡啶类药物及血小板糖蛋白Ⅱb/Ⅲa受体抑制剂等单药用于急性IS治疗的安全性和有效性目前尚缺乏足够证据,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。对无法采用华法林治疗的高危房颤患者,阿司匹林或阿司匹林+氯吡格雷双联治疗是当前比较推崇的补充选择手段。

Antiplatelet therapy is an important component for primary and secondary prevention of ischemic stroke. Patients with acute ischemic stroke who failed to thrombolytic therapy should be administered with aspirin as early as possible. There are no sufficient evidences for the efficacy and safety of other antiplatelet drugs such as thienopyridines and GP Ⅱ b/Ⅲ a receptor inhibitors used alone in the treatment of acute ischemic stroke. The effects and possible risks of the combination of antiplatelet drugs needs further studies. For the patients with high-risk atrial fibrillation, aspirin or aspirin plus clopidogrel are the complementary treatments when warfarin is not applicable.