德国汉诺威医学院29日发表公报称，由潘生丁（又名双嘧达莫）和阿司匹林制成的复方制剂能够安全有效地预防中风复发。
迄今，医生一般建议中风患者服用阿司匹林这种安全性很高的药物，以降低中风复发的风险。而潘生丁和阿司匹林复方制剂早已用于预防血栓，但用这种复方制剂治疗中风则有争议。
汉诺威医学院的研究人员称，他们的最新研究显示，潘生丁和阿司匹林复方制剂与阿司匹林同样安全，而且预防效果更好。这种复方制剂不仅像阿司匹林一样能够降低血液黏稠度以防止血小板堆积，还能减轻血管壁炎症。中风患者越早服用这种复方制剂，中风复发的可能性就越小。
这项研究先后有来自德国各医院的250名医生参与，共计研究了543名中风患者。研究人员说，首次中风后头3个月内复发的几率大概是15％到20％。服用阿司匹林能使中风复发的风险降低约17％，而潘生丁和阿司匹林复方制剂则平均能使中风复发风险降低30％。
这一研究成果已发表在最新一期专业杂志《柳叶刀神经病学》上。
推荐原始出处：
The Lancet Neurology, Volume 9, Issue 2, Pages 159 - 166, February 2010 doi:10.1016/S1474-4422(09)70361-8
Early treatment with aspirin plus extended-release dipyridamole for transient ischaemic attack or ischaemic stroke within 24 h of symptom onset (EARLY trial): a randomised, open-label, blinded-endpoint trial
Reinhard Dengler MD a , Hans-Christoph Diener MD b, Andreas Schwartz MD c, Martin Grond MD d, Helmut Schumacher PhD e, Thomas Machnig MD f, Christoph Cyrill Eschenfelder MD e g, Joachim Leonard PhD e, Karin Weissenborn MD a, Andreas Kastrup MD h, Roman Haberl MD i, for the EARLY investigators?
Background
Little is known about the best antiplatelet treatment immediately after ischaemic stroke or transient ischaemic attack (TIA). The EARLY trial aimed to compare outcome in patients given aspirin plus extended-release dipyridamole twice daily either within 24 h of stroke or TIA or after 7 days of aspirin monotherapy.
Methods
In 46 stroke units in Germany, patients aged 18 years or more who presented with symptoms of an acute ischaemic stroke that caused a measurable neurological deficit (National Institutes of Health stroke scale score ≤20) were randomly assigned to receive 25 mg aspirin plus 200 mg extended-release dipyridamole open-label twice daily or 100 mg aspirin monotherapy open-label once daily for 7 days. Patients were randomised by use of a pseudorandom number generator. All patients were then given open-label aspirin plus extended-release dipyridamole for up to 90 days. The primary endpoint was modified Rankin scale score as recorded by centralised, blinded assessment by telephone (tele-mRS) at 90 days. Vascular adverse events (non-fatal stroke, TIA, non-fatal myocardial infarction, and major bleeding complications) and mortality were assessed in a composite safety and efficacy endpoint. Patients were analysed as treated. This trial is registered, number NCT00562588.
Findings
Between July, 2007, and February, 2009, 543 patients were treated: 283 received early aspirin plus extended-release dipyridamole and 260 received aspirin plus extended-release dipyridamole after 7 days on aspirin. At day 90, 154 (56%) patients in the aspirin plus early extended-release dipyridamole group and 133 (52%) in the aspirin plus later extended-release dipyridamole group had no or mild disability (tele-mRS 0 or 1; difference 41%, 95% CI ?45 to 126, p=045). 28 patients in the early initiation group and 38 in the late initiation group reached the composite endpoint (hazard ratio 073, 95% CI 044―119 p=020).
Interpretation
Early initiation of aspirin plus extended-release dipyridamole within 24 h of stroke onset is likely to be as safe and effective in preventing disability as is later initiation after 7 days.
Funding
Boehringer Ingelheim.
