阿司匹林与氯吡格雷预防或治疗缺血性脑卒中致出血并发症的系统评价

Bleeding complications caused by preventing or treating of aspirin and clopidogrel for ischemic stroke: a systematic review

目的对阿司匹林与氯吡格雷预防或治疗缺血性脑卒中(IS)导致出血并发症风险进行评价。方法计算机检索Pub Med、EMBase、The Cochrane Library、CBM、CNKI、VIP和Wang Fang Data等数据库。检索自建库截止至2016年9月。搜集阿司匹林与氯吡格雷预防或治疗IS且产生出血并发症的随机对照试验(RCT)。由2位研究人员独立进行文献筛选、数据提取和质量评价后,采用Rev Man 5.2软件进行Meta分析。结果共纳入13个RCT,包括5204例患者。Meta分析结果显示:(1)预防IS时,阿司匹林相比氯吡格雷不增加皮肤黏膜、牙龈出血风险,但增加消化道出血风险;阿司匹林和氯吡格雷联用相比阿司匹林单用增加胃肠道反应。(2)治疗IS时,阿司匹林相比氯吡格雷不增加皮肤黏膜、牙龈、消化道出血风险,不增加胃肠道反应;阿司匹林和氯吡格雷联用相比阿司匹林单用亦不增加皮肤黏膜、牙龈、消化道、颅脑出血风险,不增加胃肠道反应。结论预防IS时,阿司匹林相比氯吡格雷会增加消化道出血风险,阿司匹林和氯吡格雷联用相比阿司匹林单用会增加胃肠道反应。

Aim To assess the bleeding complications caused by preventing or treating of aspirin and clopidogrel for ischemic stroke （IS）. Methods The databases including PubMed, EMBase, The Cochrane Library, CBM, CNKI, VIP and Wang Fang Data were retrieved by using computer, and retrieval was from the database building until September 2016. The ran- domized controlled trials （RCT） were collected on aspirin and clopidogrel to prevent or treat IS and causing bleeding complica- tions. The Meta analysis was carried out by RevMan 5.2 software after 2 researchers independently conducted literature screen- ing, data extraction and quality evaluation. Results A total of 13 RCTs, including 5204 patients, were enrolled. Meta a- nalysis showed： （1） In the prevention of IS, compared with clopidogrel, aspirin did not increase the risks of mucocutaneous and gingival bleeding, but increased the risk of gastrointestinal bleeding; Compared with aspirin alone, aspirin and clopidogrel com- bination increased gastrointestinal response. （2） In the treatment of IS, compared with clopidogrel, aspirin did not increase the risks of mueocutaneous, gingival bleeding and gastrointestinal bleeding, without increasing gastrointestinal response; Compared with aspirin alone, the combination of aspirin and clopidogrel did not increase the risks of skin, mucous membranes, gums, di- gestive tract and brain hemorrhage, and did not increase the gastrointestinal response. Conclusion In the prevention of IS, aspirin can increase the risk of gastrointestinal bleeding when compared with clopidogrel, and the combination of aspirin and clo- pidogrel can increase gastrointestinal response when compared with aspirin alone.