Effect of aspirin plus clopidogrel on platelet function and prognosis in patients with acute cerebral infaction
1.Department of Neurology, the Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325200; 2.Department of Neurology, People’s Hospital of Deyang City, Deyang, 618000
CHI Wanzhang1,ZHOU Qiang1,LIN Jing1, et al. Effect of aspirin plus clopidogrel on platelet function and prognosis in patients with acute cerebral infaction[J]. JOURNAL OF WEZHOU MEDICAL UNIVERSITY, 2015, 45(4): 273-.
Abstract：Objective: To evaluate the effects of clopidogrel combined with aspirin compared to aspirin alone on platelet function and short-term outcome in patients with acute large-artery atherosclerosis stroke. Methods: Altogether 570 patients with acute (≤72 h) atherosclerotic cerebral infarction were randomly assigned to receive combined clopidogrel with aspirin and aspirin alone. Platelet aggregation and platelet-leukocyte aggregation were detected at day 1 and day 30. Primary outcome was neurological deterioration, second outcomes including recurrent ischemic stroke, periphery vascular events, myocardial infarction and all cause deaths. Safety endpoints were hemorrhagic episodes and death in 30 days. Results: Patients who received the combination therapy had significantly fewer ischemic stroke recurrence events and neurological deterioration than those given monotherapy. At day 30 of treatment, the platelet aggregations and platelet-leukocyte aggregation were lower than those patients given aspirin alone (P<0.01). Compared to patients who did not suffer neurological deterioration or recurrent stroke, the platelet aggregation induced by arachidonic acid or ADP, and platelet-leukocyte aggregation, at day 1 were higher than those patients who did experience these afflictions (P<0.01). Conclusion: Treatment with combined clopidogrel and aspirin provides significantly greater inhibition of platelet activity than did aspirin alone, and appears to be safer and more effective in reducing ischemic stroke recurrence and neurological deterioration.
[1] Diener HC, Cunha L, Forbes C, et al. European Stroke Prevention Study 2: Dipyridamole and acetylsalicylic acid in the secondary prevention of stroke[J]. J Neurol Sci, 1996,143(1-2): 1-13.
[2] CAPRIE Steering Committee. A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischemic events[J]. Lancet, 1996, 348(9038): 1329-1339.
[3] Gurbel PA, Bliden KP, Hiatt BL, et al. Clopidogrel for coronary stenting: response variability,drug resistance and the effect of pretreatment platelet reactivity[J]. Circulation,2003, 107(23): 2908-2913.
[4] Yi X, Zhou Q, Lin J, et al. Platelet response to aspirin in chinese stroke patients is independent of genetic polymor-phisms of COX-1 C50T and COX-2 G765C[J]. J Atheroscler Thromb, 2013, 20(1): 65-72.
[5] Han SW, Kim SH, Lee JY, et al. A new subtype classification of ischemic stroke based on treatment and etiologic mechanism[J]. Eur Neurol, 2007, 57(2): 96-102.
[6] Yi X, Lin J, Wang C, et al. Low-molecular-weight heparin is more effective than aspirin in preventing early neurologic deterioration and improving six-month outcome[J]. J Stroke Cerebrovasc Dis, 2014, 23(6): 1537-1544.
[7] Awadh M, MacDougall N, Santosh C, et al. Early recurrent ischemic stroke complicating intravenous thrombolysis for stroke: incidence and association with atrial fibrillation[J]. Stroke, 2010, 41(9): 1990-1995.
[8] Alawneh JA, Moustafa RR, Baron JC. Hemodynamic factors and perfusion abnormalities in early neurological deterioration[J]. Stroke, 2009, 40(6): e443-e450.
[9] Lavallée PC, Labreuche J, Faille D, et al. Circulating markers of endothelial dysfunction and platelet activation in patients with severe symptomatic cerebral small vessel disease[J].Cerebrovasc Dis, 2013, 36(2): 131-138.
[10] 周强, 易兴阳, 池丽芬. 血小板白细胞聚集体及其临床意义[J]. 温州医学院学报, 2010, 40(1): 96-99.
[11] Makkar RR, Eigler NL, Kaul S, et al. Effects of clopidogrel, aspirin and combined therapy in a porcine ex vivo model of high-shear induced stent thrombosis[J]. Eur Heart J, 1998, 19(10): 1538-1546.
[12] Yusuf S, Zhao F, Mehta SR, et al. Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation[J]. N Engl J Med, 2001, 345 (20): 1506.
[13] Diener HC, Bogousslavsky J, Brass LM, et al. Aspirin and clopidogrel compared with clopidogrel alone after recent ischaemic stroke or transient ischaemic attack in high-risk patients (MATCH): randomised, double-blind, placebo-controlled trial[J]. Lancet, 2004, 364(9431): 331-337.
[14] Bhatt DL, Fox KA, Hacke W, et al. Clopidogrel and aspirin versus aspirin alone for the prevention of atherothrombotic events[J]. N Engl J Med, 2006, 354(16): 1706-1717.
[15] Wong KS, Chen C, Fu J, et al. Clopidogrel plus aspirin versus aspirin alone for reducing embolisation in patients with acute symptomatic cerebral or carotid artery stenosis (CLAIR study): a randomised, open-label, blinded-endpoint trial[J]. Lancet Neurol, 2010, 9(5): 489-497.
[16] Markus HS, Droste DW, Kaps M, et al. Dual antiplatelet therapy with clopidogrel and aspirin in symptomatic carotid stenosis evaluated using doppler embolic signal detection: the Clopidogrel and Aspirin for Reduction of Emboli in Symptomatic Carotid Stenosis (CARESS) trial[J]. Circulation, 2005, 111(17): 2233-2240.
[17] Wang Y, Wang Y, Zhao X, et al. Clopidogrel with aspirin in acute minor stroke or transient ischemic attack[J]. N Engl J Med, 2013, 369(1): 11-19.
