Curative Effect Observation And Security Research About Short-term Dual Antiplatelet Therapy With Transient Ischemic Attack And Prediction

Background and the significance:The incidence of cerebrovascular disease in our country is a high. There aremillions of new patients every year, the majority of are transient ischemic attack, TIAis flash, can be recovery in a short period of time, and can break out repeatedly,because its development into the probability of cerebral infarction is very big, so wecall it the "warning signs" of brain infarction. Caused by cerebral infarction with highmorbidity and high mortality rate, add a great deal of social and medical burden. Weactively explore the treatment of cerebral infarction on one hand, from "cure disease"for the development of "cure before diaease", especially the TIA this "the diseasebefore disease", such as can reduce the probability of TIA to cerebral infarction, willreduce the number of most of the patients with cerebral infarction. TIA treatmentearly treatment is the key, antiplatelet therapy is the basis. At present in our countrycommonly used antiplatelet drugs for aspirin and clopidogrel. The two drugs havedefinite antiplatelet aggregation treatment effect, due to different targets, both intheory is the combination can produce synergies, than monotherapy curative effect isbetter. But inevitably antiplatelet therapy of the risk of bleeding and bleeding riskappeared two drug combination and the incidence of adverse reactions to larger, howto gain maximum efficacy and reduce adverse reaction of seeking balance, is the keyof antiplatelet therapy. This study tries to through the different treatment efficacycompared to explore a more reasonable TIA antiplatelet therapy. ABCD2score forTIA prognostic prediction score, on the onset of TIA characteristics and risk factors of six characteristics, can be layered on the degree of danger of TIA patients, vascularevaluation and the evaluation of the nuclear magnetic ABCD3I scoring himself on amore accurate assessment of the risk in patients with TIA ABCD2and ABCD3I scorethis study compared the accuracy of the evaluation, to find a more accurate riskstratification of TIA evaluation socre.The research methods：Selected from January to August14years in our hospital treated103cases ofneurology of diagnosis of TIA or out for symptoms of hospitalized patients with TIAsymptoms, were randomly divided into3groups, load double resistance groups:application of aspirin+clopidogrel300mg of the load3days, after giving aspirin100mg/day+clopidogrel100mg/day,15days treatment, application of aspirin after100mg/day or clopidogrel treatment alone100mg/day for6months; A total of36cases.Double resistance groups: used aspirin100mg/day+clopidogrel75mg/day,treatment,15days after the application of100mg/day or aspirin clopidogrel100mg/day6months alone,32cases were collected; Sheet resistance groups: applicationof100mg/day or aspirin clopidogrel75-100mg/day6months alone, a total of35cases. Other treatments include application of proprietary Chinese medicine, toimprove circulation drugs and stable plaques statin drugs, brain protective agent andneurotrophic drugs, but there was no difference in the three groups. All patients withABCD2and ABCD3I score. In3months and6months after discharge by telephonefollow-up, curative effect is judged to be powerfully: completely relieve symptoms,no TIA event happen again within six months; Effective: completely relievesymptoms, but there is still a TIA attacks within six months, not progress for cerebralinfarction; Invalid: TIA break out repeatedly, progress of cerebral infarction. As wellas the records of adverse reactions. Application of statistical methods for three sets of 3months and6months after the onset of the prognosis of statistical analysis, toABCD2score and ABCD3I score to evaluate the accuracy of the situation.The results of the study：103patients of average age was57.59±11.28years old, Three groupsrespectively into36,32and35patients. Hospital3days of observation, load doubleresistance group5.6%(2cases) patients still had seizures,2.8%(1case) for thedevelopment of infarction; Double resistance group18.8%(6cases), patients stillhave attack6.3%(2cases) for the development of infarction, aspirin group,22.9%(8cases), there are still attacks11.4%(4cases) development to infarction. Three groupsof statistical analysis to load double anti curative effect is better than that of the rest ofthe2groups; Double15days observation, load resistance group5.6%(2cases)patients still had seizures,5.6%(2case) for the development of infarction; Doubleresistance group9.38%(3cases), patients still have attack12.5%(4cases) for thedevelopment of infarction, aspirin group17.1%(6cases) are still attack,17.1%(6cases) development to infarction.3months follow-up, load resistance group5.6%(2cases) patients still had seizures,8.3%(3cases) for the development of infarction;Double resistance group18.8%(6cases), patients still have attack12.5%(4cases) forthe development of infarction, aspirin group,20%(7cases), there are still attacks22.9%(8cases) development to infarction. Three groups of statistical analysis, P=0.047<0.05, the difference is statistically significant. In patients with recurrent TIApatients, there are major artery stenosis patients and the ABCD score for patients withhigh risk for individual analysis, results show that the double load resistance totherapy treatment effect is superior to the other two groups. All103patients were1case of occurrence of intracranial hemorrhage,3groups the incidence of adverse reactions. To ABCD2and ABCD3I two score ROC curve inspection, ABCD3Iscoring area under the curve was62.6%, p=0.033<0.05.Conclusion:1, TIA acute phase used aspirin+clopidogrel (300mg) load to the treatment for3consecutive days+clopidogrel and aspirin (100mg) dose compared with aspirin(100mg), with the application three days later can significantly reduce the recurrencerate and infarction rate of symptoms;2, TIA acute stage application of aspirin+clopidogrel (300mg) load to theapplication for3consecutive days+clopidogrel and aspirin (100mg)15days afterthe application of aspirin alone100mg dose compared with other treatment cansignificantly reduce the TIA patients with15days and3months of symptomrecurrence rate and infarction rate;3, for patients with recurrent TIA, loading dose of clopidogrel and aspirinapplication three days out to effectively suspended again;4, for existing main artery stenosis and the ABCD score in high-risk patients,suggest that application of the double resistance to treatment, load double antitreatment effect is better.5, loading doses to treat TIA is safe and effective, does not increase the incidenceof adverse reactions, no intracranial hemorrhage occurred;6, ABCD3I score higher accuracy compared with ABCD2score for predictinginfarction.