氯吡格雷联合阿司匹林与低分子肝素联合阿司匹林治疗短暂性脑缺血发作近期疗效观察

Comparative observation of Clopidogrel and Aspirin versus Low-molecular-weight Heparin and Aspirin in transient ischemic attack patients

目的探讨氯吡格雷联合阿司匹林与低分子肝素联合阿司匹林治疗短暂性脑缺血发作(transient ischemic attack,TIA)的疗效。方法收集入院治疗的102例TIA患者,按ABCD3-I评分法分为低(<4)、中高危(≥4)2组,每组再随机分为双抗(氯吡格雷+阿司匹林)组和抗凝(低分子肝素+阿司匹林)组。观察7d内2组TIA控制率,记录不良反应,随访1个月。结果低危组的双抗组有效率(97.6%)略高于抗凝组(95.1%,P=0.556);中高危组的抗凝组有效率(90.0%)高于双抗组(80.0%),差异无统计学意义(P>0.05)。双抗组不良反应均低于抗凝组,差异无统计学意义(P>0.05)。结论对ABCD3-I评分≤4的低危患者优先选择氯吡格雷联合阿司匹林治疗,对ABCD3-I评分≥4的中高危患者,低分子肝素联合阿司匹林的近期疗效可能优于氯吡格雷联合阿司匹林。

Objective To compare the clinical efficacy of clopidogrel and aspirin（ASA） versus low‐molecular‐weight hepa‐rin（LMWH） and aspirin in patients with transient ischemic attack（TIA） .Methods 102 cases with TIA were classified into two groups according to the ABCD3‐I scores：low risk group （ABCD3‐I 〈4 scores） and moderate‐high risk group（ABCD3‐I ≥4 scores） .Furthermore ,two groups were randomly divided into ASA subgroup （ clopidogrel and aspirin ） and LMWH subgroup （low‐molecular‐weight heparin and aspirin ） .We recorded control rate to assess therapeutic effect and presented adverse events within 7‐day treatment ,and kept 1‐month follow‐up .Results In low risk group ,the control rate in ASA subgroup （97 .6% ） was slightly higher than that in LMWH subgroup （95 .1% ） .And conversely ,in moderate‐high risk group ,LMWH subgroup （90 .0% ） obtained the higher control rate than ASA subgroup （80 .0% ） with no statistical difference .Although the adverse e‐vents in ADR subgroup were less than that in LMWH subgroup ,there was no significant difference in terms of incidence .Con‐clusion The present study demonstrates that low risk patients with ABCD3‐I 〈4 scores should consider the therapy of clopi‐dogrel and aspirin as first choice ,and as for moderate‐high risk patients with ABCD3‐I ≥4 scores ,low‐molecular‐weight hepa‐rin and aspirin maybe has better short‐time efficacy than clopidogrel and aspirin .