| Objectives To investigate the clinical efficacy of triple antiplatelet(aspirin and clopidogrel and indobuprofen or ozagrel sodium injection)in the treatment of high-risk non-disabling ischemic cerebrovascular disease.Methods A total of 128 patients who were admitted to Department of Neurology,Affiliated Hospital of North China University of Science and Technology within 48 hours of onset and were diagnosed as high-risk TIA or confirmed as minor stroke by craniocerebral CT or MRI and could receive antiplatelet aggregation therapy were collected.After admission,64 patients were randomly divided into double antiplatelet group(given two antiplatelet drugs at the same time,referred to as double antiplatelet group)and triple antiplatelet group(given three antiplatelet drugs at the same time,referred to as triple antiplatelet group).Both groups were given anti-platelet treatment,lipid regulation and plaque stabilization,nerve nutrition,free radical scavenging,circulation improvement,blood pressure control,blood glucose control and other treatments according to the Chinese Guidelines for the Diagnosis and Treatment of Acute Ischemic Stroke 2018.Among them,aspirin(100mg,once a day)and clopidogrel(75mg,once a day)for 21 days in the dual antiplatelet group,aspirin(100mg,once a day,for 21days)and clopidogrel(75mg,once a day,for 21 days)and indobufen tablet(200mg,twice a day)for the triple antiplatelet group.7 days)or ozagrel sodium injection(80mg,twice daily,for 7 days).NIHSS score(mild stroke patients),ADL score,and the probability of adverse outcome(secondary TIA or acute cerebral infarction)and medication safety were compared between the two groups after discharge and 90 days.Results 1 Among the 128 patients collected,there were 64 patients in the triple antiplatelet group and the double antiplatelet group;Fifty-nine patients were diagnosed with high-risk transient ischemic attack and 69 patients with minor stroke.2.Patients with adverse outcomes :(1)A total of 12 patients with high-risk non-disabling ischemic cerebrovascular disease had adverse outcomes,including 3 cases in the triple antiplatelet group and 9 cases in the double antiplatelet group.The third antiplatelet group was lower than the double antiplatelet group,but the difference was not statistically significant(P>0.05).2.The ADL scores at discharge and 90 days in the third antiplatelet group were68(65,70)and 75(70,75),while those in the double antiplatelet group were 65(61.25,65)and 70(70,75),with statistical difference(P<0.05).3 Intracranial hemorrhage occurred in2 patients(3.1%)in both groups;There were 2 cases(3.1%)in the triple antiplatelet group and 1 case(1.6%)in the double antiplatelet group.There were 3 cases(4.7%)in the triple antiplatelet group and 2 cases(3.1%)in the double antiplatelet group.There were more bleeding events in the triple antiplatelet group than in the double antiplatelet group,but the difference was not significant(P>0.05).4.Subgroup analysis :(1)Among patients diagnosed with high-risk TIA,there were 2 cases in the triple antiplatelet group and 3 cases in the double antiplatelet group,and there was no significant difference in adverse outcomes(P>0.05).The discharge and ADL scores of high-risk TIA patients without adverse outcomes in the triple antiplatelet group were higher than those in the double antiplatelet group at 90 days,with statistical differences(P<0.05).Intracranial hemorrhage occurred in 1 patient(3.1%)in the triple antiplatelet group,while no intracranial hemorrhage occurred in the double antiplatelet group.Gastrointestinal bleeding occurred in1 case(3.1%)in triple antibody group and 1 case(3.7%)in double antibody group.There was 1 case(3.1%)of skin and mucosal hemorrhage in the triple antiplatelet group,and no case in the double antiplatelet group.The bleeding events in the triple antiplatelet group were more than those in the double antiplatelet group,but there was no statistical difference(P>0.05).(2)The adverse outcomes of patients diagnosed with minor stroke were 1(3.1%)in the triple antiplatelet group and 6(16.2%)in the double antiplatelet group,with no statistically significant difference(P>0.05).The NIHSS score of minor stroke patients without adverse outcomes in the triple antiplatelet group was lower than that in the double antibody antiplatelet group at discharge and 90 days later,while the ADL score was higher than that in the double antiplatelet group,with statistical significance(P<0.05).Intracranial hemorrhage occurred in 1 case(3.1%)in the triple antiplatelet group and 2cases(5.4%)in the double antiplatelet group in the minor stroke patients.Gastrointestinal bleeding occurred in 1 case(3.1%)in the triple antiplatelet group and no case(3.1%)in the double antiplatelet group.There were 2 cases(6.3%)of skin and mucosal bleeding in the triple antiplatelet group and 2 cases(5.4%)in the double antiplatelet group.There were more bleeding events in triple antiplatelet group than in double antiplatelet group,but the difference was not statistically significant(P>0.05).Conclusions The combination of the three antiplatelet agents was not superior to the dual antiplatelet regimen in reducing 90-day adverse outcomes(recurrent TIA or acute cerebral infarction)in patients with high-risk non-disabling ischemic cerebrovascular disease,but it improved the degree of neurological impairment and the ability to live daily at 90 days without increasing the risk of bleeding.Figure 0;Table 14;Reference 86... |
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