欧洲中风预防研究。双嘧达莫与乙酰水杨酸在脑卒中二级预防中的作用。

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李志刚，李志刚，李志刚，李志刚，李志刚

欧洲中风预防研究。双嘧达莫与乙酰水杨酸在脑卒中二级预防中的作用。

中华神经科学杂志，1999,11(1):1-13。

PubMed ID

8981292 (PubMed视图

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摘要

1988年，我们进行了一项随机、安慰剂对照、双盲试验，探讨低剂量乙酰水杨酸(ASA)、减释双嘧达莫(dipyridamole)及两者联合用于缺血性脑卒中二级预防的安全性和有效性。既往有卒中或短暂性脑缺血发作(TIA)的患者被随机分为ASA单独治疗(每天50mg)、改性释放双嘧达莫单独治疗(每天400mg)、两种药物联合用药或安慰剂治疗。主要终点为中风、死亡以及中风或死亡。次要终点为TIA和其他血管事件。对患者进行为期两年的随访治疗。分析了6602例患者的数据。因子分析显示ASA和双嘧达莫在降低卒中(p <或= 0.001)和卒中或死亡合并风险(p < 0.01)方面具有极显著作用。在两两比较中，与安慰剂相比，ASA单独组中风风险降低了18% (p = 0.013);16%单独使用双嘧达莫(p = 0.039);联合治疗37% (p < 0.001)。 Risk of stroke or death was reduced by 13% with ASA alone (p = 0.016); 15% with dipyridamole alone (p = 0.015); and 24% with the combination (p < 0.001). The treatment had no statistically significant effect on the death rate alone. Factorial analysis also demonstrated a highly significant effect of ASA (p < 0.001) and dipyridamole (p < 0.01) for preventing TIA. The risk reduction for the combination was 36% (p < 0.001) in comparison with placebo. Headache was the most common adverse event, occurring more frequently in dipyridamole-treated patients. All-site bleeding and gastrointestinal bleeding were significantly more common in patients who received ASA in comparison to placebo or dipyridamole. We conclude that (1) ASA 25 mg twice daily and dipyridamole, in a modified-release form, at a dose of 200 mg twice daily have each been shown to be equally effective for the secondary prevention of ischemic stroke and TIA; (2) when co-prescribed the protective effects are additive, the combination being significantly more effective than either agent prescribed singly; (3) low-dose ASA does not eliminate the propensity for induced bleeding.

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双嘧达莫