| The cerebrovascular disease have been paid more and more attention, because of its morbidity disability and mortality were higher, and has brought great harm and economic burden to individuals, families and socity, so the treatment and prevention of cerebrovascular disease is already the focus work of clinical doctors. Ischemic stroke and TIA accounted for most of erebrovascular disease. Thrombolysis and antiplalelet therapy is the effective methods in current. Thrombolysis therapy has a strict time windows, so many patients miss the time window of Thrombolysis therapy. Antiplatelet therapy has become the main treatment method for ischemic stroke and TIA. Antiplatelet drugs have many types such as aspirin, clopidogrel, dipyridamole, abcixmab and other drugs.Aspirin and clopidogrel have different mechanisms on antiplatelet function, so that the combined method will be more effective inhibition of platelet activation and aggregation, which play an important role in treatment and prevention.This study seareh were applied to the following electronic databases: Medline; Pubmed; high wire press; CNKI and other databases about"aspirin plus clopidogrel, early recurrence, TIA or acute ischemic stroke, randomiz controlled trials RCTs"searching in English; or"clopidogrel plus aspirin, TIA, acute ischemic stroke"searching in Chinese. Sesrching in 2000-2011. According to the strict selected and exclusion, 10 trials were enrolled into the analysis. Judge the Jadad rating respectively,and excerpt their trial design, characters of the subjects, results of the studies.comparing the patients of acute ischemic stroke using aspirin plus clopidogrel with using aspirin and clopidogrel alone or aspirin plus dipyridamole,about reducing the risk of primary endpoint events;droping the incidence of microembolic and safety by using RevMan5.0.21 software.The 10 trials compared short-term treatment of acute ischemic stroke for reducing recurrence of vascular events between the experimental group and the control group are homogeneous (test for heterogeneity I2=0%, P=0.48); RR combined adopts fixed effects model, RR=0.55, 95%CI (0.40, 0.75); Test for overall effect: Z=3.71, P=0.0002. The 7 trials of accepting drugs 30-180 days compared with reducing recurrence of vasular events between the experimental and control group are homogeneous (test for heterogeneity I2=25%, P=0.24); adopting fixed effects model, RR=0.55, 95%CI (0.40,0.77); Test for overall effect: Z=3.46,P=0.0005.The 3 trials of accepting drugs 7-14 days compared with reducing recurrence of vasular events between the two group are heterogeneity (heterogeneity test I2=0%, P=0.73); adopting fixed effects model, RR=0.49, 95%CI (0.17,1.40); Test for overall effect:Z=1.34, P=0.18.The 3 trials comparing to reduce microembolic between the tow groups are heterogeneity (test for heterogeneity I2=0%, P=0.53); adopting fixed effects model, RR=0.72, 95%CI (0.56,0.91); Test for overall effect: Z=2.72, P=0.006. The 8 trials compared with bleeding between the experimental group and control group are homogeneous (test for heterogeneity I2=29%, P=0.24); RR combined adopts fixed effects model, RR=2.31, 95%CI (0.86, 6.21); Test for overall effect: Z=1.66, P=0.010.To sum up: First, the system analysis has a good effect that short-term antiplatelet combination therapy can decrease the recurrence of vascular events when using in acute ischemic stroke, and in reducing the risk of occurrence of microembolic may be effective. In this study, the safety on the experimental group and control group had no significant difference of bleeding, suggesting that short-term combination dose not increase the risk of bleeding. Because this system analysis included trials less and sample size small, so the results may have a bias, no definite conclusion can confirm the efficacy and safety of short-term anti-platelet drugs combined treatment of acute ischemic stroke. There is still need for the future design of more rigorous randomized controlled clinical trials of large sample, the methodology should be fully clear, and measures should always focus on the risk of bleeding and other adverse effects.
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