Dual Antiplatelet Therapy after Noncardioembolic Ischemic Stroke or Transient Ischemic Attack: Pros and Cons
2
조회
0
다운로드
2
인용
0
참고문헌
키워드
초록
Dual antiplatelet therapy simultaneously blocks different platelet activation pathways and mightthus be more potent at inhibiting platelet activation and more effective at reducing major ischemic vascular events compared to antiplatelet monotherapy. Aspirin plus clopidogrel dual therapy is now the standard therapy for patients with acute coronary syndrome and for those undergoing percutaneous coronary intervention. However, dual antiplatelet therapy carries an increasedrisk of bleeding. Patients with ischemic stroke or transient ischemic attack (TIA) are generallyolder and likely to have a fragile cerebrovascular bed, which further increases the risk of systemicmajor bleeding events and intracranial hemorrhage. Clinical trials and meta-analyses suggestthat in comparison to antiplatelet monotherapy, dual antiplatelet therapy initiated early afternoncardioembolic ischemic stroke or TIA further reduces the rate of recurrent stroke and majorvascular events without significantly increasing the rate of major bleeding events. In contrast,studies of long-term therapy in patients with noncardioembolic ischemic stroke or TIA haveyielded inconsistent data regarding the benefit of dual antiplatelet therapy over monotherapy. However, the harm associated with major bleeding events, including intracranial hemorrhage,which is generally more disabling and more fatal than ischemic stroke, is likely to increase withdual antiplatelet therapy. Physicians should carefully assess the benefits and risks of dual antiplatelet therapy versus antiplatelet monotherapy when managing patients with ischemic strokeor TIA.
Abstract
Dual antiplatelet therapy simultaneously blocks different platelet activation pathways and mightthus be more potent at inhibiting platelet activation and more effective at reducing major ischemic vascular events compared to antiplatelet monotherapy. Aspirin plus clopidogrel dual therapy is now the standard therapy for patients with acute coronary syndrome and for those undergoing percutaneous coronary intervention. However, dual antiplatelet therapy carries an increasedrisk of bleeding. Patients with ischemic stroke or transient ischemic attack (TIA) are generallyolder and likely to have a fragile cerebrovascular bed, which further increases the risk of systemicmajor bleeding events and intracranial hemorrhage. Clinical trials and meta-analyses suggestthat in comparison to antiplatelet monotherapy, dual antiplatelet therapy initiated early afternoncardioembolic ischemic stroke or TIA further reduces the rate of recurrent stroke and majorvascular events without significantly increasing the rate of major bleeding events. In contrast,studies of long-term therapy in patients with noncardioembolic ischemic stroke or TIA haveyielded inconsistent data regarding the benefit of dual antiplatelet therapy over monotherapy. However, the harm associated with major bleeding events, including intracranial hemorrhage,which is generally more disabling and more fatal than ischemic stroke, is likely to increase withdual antiplatelet therapy. Physicians should carefully assess the benefits and risks of dual antiplatelet therapy versus antiplatelet monotherapy when managing patients with ischemic strokeor TIA.
참고문헌 (39)
- Keun-Sik Hong, "Stroke Statistics in Korea: Part I. Epidemiology and Risk Factors: A Report from the Korean Stroke Society and Clinical Research Center for Stroke", 대한뇌졸중학회지, 15(1), pp.2~20 (2013), 대한뇌졸중학회[DOI]
- Jung KH, "Secular trends in ischemic stroke characteristics in a rapidly developed country:results from the Korean Stroke Registry Study (secular trends in Korean stroke)", Circ Cardiovasc Qual Outcomes, 5, pp.327~334 (2012)
- Antithrombotic Trialists’ Collaboration, "Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients", BMJ, 324, pp.71~86 (2002)
- Hong KS, "Declining stroke and vascular event recurrence rates in secondary prevention trials over the past 50 years and consequences for current trial design", Circulation, 123, pp.2111~2119 (2011)
- 박태환, "뇌졸중 이차예방을 위한 항혈소판제의 사용: 2012년 한국 뇌졸중 이차예방 진료지침 부분 개정", 대한뇌졸중학회지, 14(1), pp.1~5 (2012), 대한뇌졸중학회[DOI]
- Yusuf S, "Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation", N Engl J Med, 345, pp.494~502 (2001)
- Chen ZM, "Addition of clopidogrel to aspirin in 45,852 patients with acute myocardial infarction:randomised placebo-controlled trial", Lancet, 366, pp.1607~1621 (2005)
- Sabatine MS, "Addition of clopidogrel to aspirin and fibrinolytic therapy for myocardial infarction with ST-segment elevation", N Engl J Med, 352, pp.1179~1189 (2005)
- Mehta SR, "Effects of pretreatment with clopidogrel and aspirin followed by long-term therapy in patients undergoing percutaneous coronary intervention: the PCI-CURE study", Lancet, 358, pp.527~533 (2001)
- Steinhubl SR, "Early and sustained dual oral antiplatelet therapy following percutaneous coronary intervention: a randomized controlled trial", JAMA, 288, pp.2411~2420 (2002)
- Sabatine MS, "Effect of clopidogrel pretreatment before percutaneous coronary intervention in patients with ST-elevation myocardial infarction treated with fibrinolytics: the PCI-CLARITY study", JAMA, 294, pp.1224~1232 (2005)
- Dengler R, "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, blindedendpoint trial", Lancet Neurol, 9, pp.159~166 (2010)
- Markus HS, "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", Circulation, 111, pp.2233~2240 (2005)
- Wong KS, "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", Lancet Neurol, 9, pp.489~497 (2010)
- Kennedy J, "Fast assessment of stroke and transient ischaemic attack to prevent early recurrence (FASTER): a randomised controlled pilot trial", Lancet Neurol, 6, pp.961~969 (2007)
- Kennedy J, "The fast assessment of stroke and transient ischemic attack to prevent early recurrence (FASTER) trial", Proceedings of the 2006 International Stroke Conference (2006), American Heart Association
- Wang Y, "Clopidogrel with aspirin in acute minor stroke or transient ischemic attack", N Engl J Med, 369, pp.11~19 (2013)
- Johnston SC, "Platelet-oriented inhibition in new TIA and minor ischemic stroke (POINT) trial: rationale and design", Int J Stroke, 8, pp.479~483 (2013)
- Geeganage CM, "Dual or mono antiplatelet therapy for patients with acute ischemic stroke or transient ischemic attack: systematic review and meta-analysis of randomized controlled trials", Stroke, 43, pp.1058~1066 (2012)
- Wong KS, "Early dual versus mono antiplatelet therapy for acute non-cardioembolic ischemic stroke or transient ischemic attack: an updated systematic review and meta-analysis", Circulation, 128, pp.1656~1666 (2013)
- Bousser MG, "“AICLA” controlled trial of aspirin and dipyridamole in the secondary prevention of athero-thrombotic cerebral ischemia", Stroke, 14, pp.5~14 (1983)
- The American-Canadian Co-Operative Study group, "Persantine Aspirin Trial in cerebral ischemia. Part II: Endpoint results", Stroke, 16, pp.406~415 (1985)
- The European Stroke Prevention Study (ESPS), "Principal end-points. The ESPS Group", Lancet, 2, pp.1351~1354 (1987)
- "European Stroke Prevention Study 2: efficacy and safety data. 8. Safety", J Neurol Sci, 151(Suppl), pp.S41~S51 (1997)
- De Schryver EL, "Cochrane review: dipyridamole for preventing major vascular events in patients with vascular disease", Stroke, 34, pp.2072~2080 (2003)
- ESPRIT Study Group, "Aspirin plus dipyridamole versus aspirin alone after cerebral ischaemia of arterial origin (ESPRIT): randomised controlled trial", Lancet, 367, pp.1665~1673 (2006)
- CAPRIE Steering Committee, "A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). CAPRIE Steering Committee", Lancet, 348, pp.1329~1339 (1996)
- Diener HC, "European Stroke Prevention Study. 2. Dipyridamole and acetylsalicylic acid in the secondary prevention of stroke", J Neurol Sci, 143, pp.1~13 (1996)
- Thijs V, "Network meta-analysis: simultaneous meta-analysis of common antiplatelet regimens after transient ischaemic attack or stroke", Eur Heart J, 29, pp.1086~1092 (2008)
- Sacco RL, "Aspirin and extended-release dipyridamole versus clopidogrel for recurrent stroke", N Engl J Med, 359, pp.1238~1251 (2008)
- Diener HC, "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", Lancet, 364, pp.331~337 (2004)
- Bhatt DL, "Clopidogrel and aspirin versus aspirin alone for the prevention of atherothrombotic events", N Engl J Med, 354, pp.1706~1717 (2006)
- Bhatt DL, "Patients with prior myocardial infarction, stroke, or symptomatic peripheral arterial disease in the CHARISMA trial", J Am Coll Cardiol, 49, pp.1982~1988 (2007)
- Hankey GJ, "Effect of clopidogrel plus ASA vs. ASA early after TIA and ischaemic stroke: a substudy of the CHARISMA trial", Int J Stroke, 6, pp.3~9 (2011)
- SPS3 Investigators, "Effects of clopidogrel added to aspirin in patients with recent lacunar stroke", N Engl J Med, 367, pp.817~825 (2012)
- Lee M, "Riskbenefit profile of long-term dual- versus single-antiplatelet therapy among patients with ischemic stroke: a systematic review and metaanalysis", Ann Intern Med, 159, pp.463~470 (2013)
- Furie KL, "Guidelines for the prevention of stroke in patients with stroke or transient ischemic attack: a guideline for healthcare professionals from the american heart association", american stroke association, 2011, pp.42, 227~276
- European Stroke Organisation (ESO) Executive Committee, "Guidelines for management of ischaemic stroke and transient ischaemic attack 2008", Cerebrovasc Dis, 25, pp.457~507 (2008)
- Clinical Research Center for Stroke, "Clinical Practice Guideline for Stroke", Clinical Research Center for Stroke, ~ (2013)