替格瑞洛与阿司匹林治疗急性脑卒中及短暂性脑缺血发作的临床疗效比较

Clinical Efficacy Comparison of Ticagrelor and Aspirin in Treatment of Acute Stroke and Transient Ischemic Attack

关键词:  替格瑞洛  阿司匹林  急性脑卒中  短暂性脑缺血发作  卒中复发率

Key words:  ticagrelor  aspirin  acute stroke  transient ischemic attack  stroke recurrence rate

摘要:

目的 比较替格瑞洛与阿司匹林在急性脑卒中及短暂性脑缺血发作患者中预防卒中复发的临床疗效和安全性。方法 以急性脑卒中和短暂性脑缺血发作患者为研究对象，卒中症状发生后的24 h内随机分配接受替格瑞洛或阿司匹林治疗。观察治疗后90 d内主要终点事件（复发性卒中、心血管事件或全因死亡）以及次要终点事件（出血和呼吸困难）的发生率。结果 共纳入1 307例患者，替格瑞洛组651例，阿司匹林组656例。治疗90 d内，替格瑞洛组47例患者（7.2%）发生主要终点事件，其中38例复发缺血性卒中（5.9%）；阿司匹林组52例患者（7.9%）发生主要终点事件，其中44例复发缺血性卒中（6.8%）。替格瑞洛治疗能显著降低二次卒中的发生率（P=0.03）。对于次要终点事件观察发现：替格瑞洛组发生轻微出血8例（1.3%），呼吸困难40例（6.2%）；阿司匹林组轻微出血4例（0.6%），呼吸困难9例（1.4%）；替格瑞洛组轻微出血和呼吸困难的发生率略高于阿司匹林治疗组。结论 对于急性脑卒中或短暂性脑缺血发作的患者，相比于阿司匹林治疗，替格瑞洛能够显著降低患者二次卒中的发生率。

Abstract:

OBJECTIVE To compare the clinical efficacy and safety of ticagrelor and aspirin in the prevention of stroke recurrence in patients with acute stroke or transient ischemic attack. METHODS Patients with acute stroke or transient ischemic attack were included in this study within 24 h of clinical symptoms of stroke and assigned to receive ticagrelor or aspirin treatment. The primary endpoints included recurrent stroke, cardiovascular events, or all-cause death and the secondary endpoints included incidence of fatal bleeding, mild bleeding, and dyspnea were observed. RESULTS A total of 1 307 patients were enrolled in this study, 651 in the ticagrelor treatment group and 656 in the aspirin treatment group. During the 90 d treatment, 47 patients(7.2%) had primary endpoints in the ticagrelor treatment group, 38 of which had recurrent ischemic stroke(5.9%). In contrast, 52 patients(7.9%) had primary endpoints in the aspirin treatment group, of which 44 cases were ischemic stroke(6.8%). So treat with ticagrelor could significantly reduce the rate of stroke relapse of stroke(P=0.03). A total of 51(7.8%) patients occurred secondary endpoints in the ticagrelor treatment group, including 8 cases of mild bleeding(1.3%), and 40 cases of dyspnea(6.2%). In aspirin treatment group, 17 patients(2.6%) had secondary endpoint events, of which 4 cases were minor bleeding(0.6%) and 9 cases were dyspnea(1.4%). So the incidence of mild bleeding and dyspnea was significantly higher in ticagrelor treatment group than in aspirin treatment group. CONCLUSION For patients with acute stroke or transient ischemic attack, ticagrelor has a better therapeutic effect than aspirin, which can significantly reduce the recurrence rate of stroke and improve the prognosis of patients.