阿司匹林联合双嘧达莫在缺血性卒中二级预防中疗效及安全性的Meta分析

Meta-analysis of efficacy and safety of aspirin and dipyridamole in the secondary prevention of ischemic stroke

目的系统评价联合应用阿司匹林及双嘧达莫在缺血性卒中二级预防中的疗效及安全性。方法检索PUBMED、Cochrane Database ofSystematic Reviews、EMBASE、中国知网、万方数据中关于联合应用阿司匹林及双嘧达莫进行卒中二级预防的随机对照试验,同时对纳入文献的参考文献进行筛选,根据纳入和排除标准严格筛选,对符合纳入标准的研究采用Revman 5.0软件进行Meta分析。结果共纳入5篇符合标准的RCT,包括脑梗死或TIA患者8619例,治疗组（联合应用阿司匹林和双嘧达莫）4315例,对照组（单用阿司匹林）4304例。Meta分析结果显示：联合应用阿司匹林和双嘧达莫进行卒中二级预防与单用阿司匹林相比,显著降低卒中复发率（OR=0.84,95%CI0.73~0.97,P=0.02）及缺血事件发生率（OR=0.80,95%C1 0.69~0.92,P=0.002）,而主要出血发生率（OR=0.91.95%CL 0.73~1.14.P=0.41）和病死率（OR=0.90,95%CI 0.78~1.04,P=0.16）无明显差异。结论与单用阿司匹林相比,联合应用阿司匹林及双嘧达莫进行卒中二级预防,能显著降低卒中复发率、缺血事件发生率,且不增加出血发生率和病死率。

Objective To evaluate the efficacy and safety of combination therapy of aspirin and dipyridamole in secondary prevention of ischemia stroke.Methods Retrieval PUBMED,Cochrane Database of Systematic Reviews,EMBASE,CNKI,found articles about conducted randomized controlled trials of combination of aspirin and dipyridamole in the secondary prevention of stroke,while the included literature references were screened according to inclusion rigorous screening and exclusion criteria,the study met the inclusion criteria for the use of Revman 5.0 Meta-analysis software.Results A total of five sub-standard RCT,including 8 619 patients with cerebral infarction or TIA,treated group（combination of aspirin and dipyridamole） of 4 315 patients,4 304 cases in the control group（aspirin alone）.Meta-analysis showed that;the combination of aspirin and dipyridamole conduct secondary prevention of stroke compared with aspirin alone,significantly reduces the recurrence rate of stroke（OR= 0.84,95%CI 0.73-0.97,P= 0.02） and lack of blood event rate（OR= 0.80,95%CI0.69-0.92,P= 0.002）,whereas the incidence of major bleeding（OR= 0.91,95%CI 0.73-1.14,P=0.41）.id mortality（OR= 0.90,95%CI 0.78-1.04,P= 0.16） showed no significant difference.Conclusion Compared with aspirin alone,the combination of aspirin and dipyridamole conduct secondary prevention of stroke,can significantly reduce the recurrence rate of stroke and the incidence of ischemic events without increasing the incidence of bleeding and mortality.