Dual Antiplatelet Therapy for Mild Stroke or Transient Ischemic Attack：from Clinical Guidelines to Real-world Evidence

doi:10.12114/j.issn.1007-9572.2021.00.545

Abstract

Abstract: Patients with mild ischemic stroke or high-risk transient ischemic attack （TIA） have higher risk of recurrent stroke or other vascular events in the early stage of onset.Evidence from recent large-scale randomized controlled trials（RCTs） about stroke has provided new understandings of early use of antiplatelet therapy in patients with mild ischemic stroke or high-risk TIA.The 2019 BMJ guidelines recommended the dual antiplatelet therapy with aspirin and clopidogrel for acute high-risk TIA and mild ischemic stroke.However，the indications for the use of this therapy are still controversial，and have not been more extensively tested in the real world.We analyzed the protocols and results of recent RCTs and clinical practice using aspirin and clopidogrel for mild stroke or high-risk TIA to find the discrepancy between guideline recommendations and clinical practice，aiming at discussing patient compliance to and benefits from wider application of the dual antiplatelet therapy.

Key words: Stroke；Ischemic attack, transient；Aspirin；Clopidogrel；Dual anti-platelet therapy；Real-world evidence

摘要： 轻型缺血性卒中和高危短暂性脑缺血发作（TIA）患者在发病早期有较高的卒中或其他血管事件复发风险。在过去几年，关于卒中的大型随机对照试验使人们对轻型缺血性卒中或高危TIA患者早期运用抗血小板治疗有了新的认识，2019年BMJ指南已推荐阿司匹林联合氯吡格雷抗血小板方案用于治疗急性期高危TIA和轻型缺血性卒中患者。但双抗的使用指征仍存在争议，尚未在真实世界中更广泛的人群中获得验证。本文结合相关临床指南，分析了近几年随机对照试验的设计方案，并借助真实世界证据，探讨目前推荐的双抗治疗在更广泛的患者群体中的依从性和获益情况。

关键词: 卒中；脑缺血发作, 短暂性；阿司匹林；氯吡格雷；双重抗血小板治疗；真实世界证据

REN Jing,WANG Yongle,LIU Tingting, et al. Dual Antiplatelet Therapy for Mild Stroke or Transient Ischemic Attack：from Clinical Guidelines to Real-world Evidence　[J]. Chinese General Practice, 2021, 24(21): 2696-2700. DOI: 10.12114/j.issn.1007-9572.2021.00.545.
任静,王永乐,刘亭亭等. 双抗治疗轻型缺血性卒中或短暂性脑缺血发作——从临床指南到真实世界研究[J]. 中国全科医学, 2021, 24(21): 2696-2700. DOI: 10.12114/j.issn.1007-9572.2021.00.545.

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