본문 바로가기
KERD
논문KCI 등재

허혈뇌졸중 치료 및 예방을 위한 항혈소판제 병용요법

Combination Antiplatelet Therapy for Treatment and Prevention of Ischemic Stroke

2

조회

0

다운로드

0

인용

0

참고문헌

키워드

주제분류신경과학

초록

Antiplatelet drugs are widely used for prevention and treatment of ischemic stroke and transient ischemic attack. Considering the limited efficacy of antiplatelet drugs, combination of antiplatelet drugs can be used to potentiate antiplatelet effect. Compared to aspirin or clopidogrel alone, the combination of aspirin and clopidogrel increased the risk of bleeding complication without any additional benefit. In patients who had nonvalvular atrial fibrillation and were ineligible for oral anticoagulant, the combination aspirin and clopidogrel was better than aspirin alone though the risk of bleeding increased significantly. In two large clinical studies, the combination of aspirin and extended-release dipyridamole was more effective than aspirin alone without increasing bleeding complication. However the result of comparison to clopidogrel alone was disappointing. The combination of aspirin and cilostazol might be better than aspirin alone in preventing the progression of symptomatic stenosis of intracranial artery. Further studies are needed to investigate the risk and benefit of the combination of antiplatelet drugs in selected group of patients with acute ischemic stroke or large artery atherosclerotic stroke. (Korean J Stroke 2010;12:88-95)

Abstract

Antiplatelet drugs are widely used for prevention and treatment of ischemic stroke and transient ischemic attack. Considering the limited efficacy of antiplatelet drugs, combination of antiplatelet drugs can be used to potentiate antiplatelet effect. Compared to aspirin or clopidogrel alone, the combination of aspirin and clopidogrel increased the risk of bleeding complication without any additional benefit. In patients who had nonvalvular atrial fibrillation and were ineligible for oral anticoagulant, the combination aspirin and clopidogrel was better than aspirin alone though the risk of bleeding increased significantly. In two large clinical studies, the combination of aspirin and extended-release dipyridamole was more effective than aspirin alone without increasing bleeding complication. However the result of comparison to clopidogrel alone was disappointing. The combination of aspirin and cilostazol might be better than aspirin alone in preventing the progression of symptomatic stenosis of intracranial artery. Further studies are needed to investigate the risk and benefit of the combination of antiplatelet drugs in selected group of patients with acute ischemic stroke or large artery atherosclerotic stroke. (Korean J Stroke 2010;12:88-95)

참고문헌 (32)

  1. Algra A, "Cumulative meta-analysis of aspirin efficacy after cerebral ischaemia of arterial origin", J Neurol Neurosurg Psychiatry, 66, pp.255~ (1999)
  2. Progress Collaborative Group, "Randomised trial of a perindopril-based blood-pressure-lowering regimen among 6,105 individuals with previous stroke or transient ischaemic attack", Lancet, 358, pp.1033~1041 (2001)
  3. Amarenco P, "Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) Investigators. High-dose atorvastatin after stroke or transient ischemic attack", N Engl J Med, 355, pp.549~559 (2006)
  4. "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)
  5. Yusuf S, "Clopidogrel in Unstable Angina to Prevent Recurrent Events Trial Investigators. 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)
  6. Diener HC, "MATCH investigators. 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)
  7. Bhatt DL, "CHARISMA Investigators. Clopidogrel and aspirin versus aspirin alone for the prevention of atherothrombotic events", N Engl J Med, 354, pp.1706~1717 (2006)
  8. ACTIVE Writing Group of the ACTIVE Investigators, "Clopidogrel plus aspirin versus oral anticoagulation for atrial fibrillation in the Atrial fibrillation Clopidogrel Trial with Irbesartan for prevention of Vascular Events (ACTIVE W): a randomised controlled trial", Lancet, 367, pp.1903~1912 (2006)
  9. ACTIVE Investigators, "Effect of clopidogrel added to aspirin in patients with atrial fibrillation", N Engl J Med, 360, pp.2066~2078 (2009)
  10. 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)
  11. Kennedy J, "FASTER Investigators. 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)
  12. Wong KS, "CLAIR study investigators. 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)
  13. Amarenco P, "Should the MATCH results be extrapolated to all stroke patients and affect ongoing trials evaluating clopidogrel plus aspirin?", Stroke, 35, pp.2606~2608 (2004)
  14. Bhatt DL, "CHARISMA Investigators. Patients with prior myocardial infarction, stroke, or symptomatic peripheral arterial disease in the CHARISMA trial", J Am Coll Cardiol, 49, pp.1982~1988 (2007)
  15. Berger PB, "CHARISMA Investigators. Bleeding complications with dual antiplatelet therapy among patients with stable vascular disease or risk factors for vascular disease: results from the Clopidogrel for High Atherothrombotic Risk and Ischemic Stabilization, Management, and Avoidance (CHARISMA) trial", Circulation, 121, pp.2575~2583 (2010)
  16. 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)
  17. 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)
  18. Dengler R, "EARLY Investigators. 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)
  19. cco RL, "PRoFESS Study Group. Aspirin and extended-release dipyridamole versus clopidogrel for recurrent stroke", N Engl J Med, 359, pp.1238~1251 (2008)
  20. "The European Stroke Prevention Study (ESPS). Principal end-points. The ESPS Group", Lancet, 2, pp.1351~1354 (1987)
  21. "Persantine Aspirin Trial in cerebral ischemia. Part II: Endpoint results. The American-Canadian Co-Operative Study group", Stroke, 16, pp.406~415 (1985)
  22. Bousser MG, "“AICLA” controlled trial of aspirin and dipyridamole in the secondary prevention of athero-thrombotic cerebral ischemia", Stroke, 14, pp.5~14 (1983)
  23. De Schryver EL, "Design of ESPRIT: an international randomized trial for secondary prevention after non-disabling cerebral ischaemia of arterial origin. European", Australian Stroke Prevention in Reversible Ischaemia Trial (ESPRIT) group, 2000, pp.10, 147~150
  24. De Schryver EL, "European", Australian Stroke Prevention in Reversible Ischemia Trial (ESPRIT) Group. ESPRIT: protocol change, 2001, pp.11, 286~
  25. "European Stroke Organisation (ESO) Executive Committee; ESO Writing Committee. Guidelines for management of ischaemic stroke and transient ischaemic attack 2008", Cerebrovasc Dis, 25, pp.457~507 (2008)
  26. Adams RJ, "American Heart Association; American Stroke. Update to the AHA", ASA recommendations for the prevention of stroke in patients with stroke and transient ischemic attack, 2008, pp.39, 1647~1652
  27. 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)
  28. Kent DM, "Stroke prevention--insights from incoherence", N Engl J Med, 359, pp.1287~1289 (2008)
  29. Kwon SU, "Cilostazol prevents the progression of the symptomatic intracranial arterial stenosis: the multicenter double-blind placebo-controlled trial of cilostazol in symptomatic intracranial arterial stenosis", Stroke, 36, pp.782~786 (2005)
  30. Caplan LR, "Thoughts evoked by MATCH and other trials", Stroke, 35, pp.2604~2605 (2004)
  31. "Paltelet-Oriented Inhibition in New Transient Ischemic Attack (TIA) (POINT) trial. NCT/00991029"[URL]
  32. "COMbination of clopidogrel and aspirin for Prevention of REcurrence in acute atherothrombotic Stroke (COMPRES)"[URL]

관련 논문AI추천

이 간행물의 다른 논문 (9건)