Clinical Analysis On The Efficacy And Safety Of Intensive Antiplatelet Therapy For Acute Ischemic Stroke

Background:Ischemic stroke is the most common type of stroke.Because of its high lethality and disability,it has become the number one killer threatening the health of urban and rural population in China,causing tremendous physical and mental suffering,domestic and economic burden to patients and their families.Antiplatelet therapy,as an important means of treatment for ischemic stroke,has been widely used in clinical.Clopidogrel combined with aspirin in intensive antiplatelet therapy for mild stroke has been recommended by a number of guidelines around the world.However,for stroke patients with NIHSS score > 3,there is no consensus on dual antiplatelet therapy in clinical practice,the efficacy and safety of dual antiplatelet therapy need further clinical observation and study.Objective:To explore the efficacy and safety of intensive antiplatelet therapy in the treatment of patients with acute cerebral infarction with NIHSS score < 15 through clinical practice,in order to provide a certain extant reference.Methods:105 patients with acute cerebral infarction who were treated for the first time in the Department of Neurology,Affiliated Hospital of Yan’an University from October 2017 to November 2018 were selected as the study subjects.After admission,the patients were randomly divided into two groups.The patients treated with clopidogrel combined with aspirin were the observation group and the patients treated with aspirin alone were the control group.There were 55 cases in the observation group and 50 cases in the control group.On the basis of routine treatment,the observation group was given clopidogrel 300 mg on the first day,followed by clopidogrel 75 mg once a day on the second to ninety days,and aspirin 100 mg once a day on the first to twenty-first days.Control group: 100-300 mg aspirin was given on the first day,and 100 mg aspirin was given once a day on the second to ninety days.NIHSS scores were performed on the day of admission,the 7th day,the 14 th day and the 21 st day.The therapeutic effect was judged by the reduction of defect score.Observe and compare the occurrence of newischemic stroke,clinical vascular events and adverse events in all patients within 90 days of treatment.Results:After 7 days,14 days and 21 days of treatment,the scores of neurological deficit(NIHSS)in the observation group and the control group were significantly better than those before treatment,and there was notable difference before and after treatment(P < 0.05).The total effective rate of 55 patients in the observation group was significantly higher than that in the control group at 7,14 and 21 days of treatment(P <0.05).Within 90 days of treatment,there were 11 cases of ischemic stroke in the treatment group,including 2 cases(3.64%)in the observation group and 9 cases(18%)in the control group.There was a notable difference between the two groups(P < 0.05).In the observation group,2 patients(3.64%)got acute coronary syndrome,and 2 patients(4.00%)in the control group(including 1 patient in the observation group and 1 patient in the control group occurred acute myocardial infarction),There was no marked difference between the two groups(P > 0.05).Vascular death occurred in 1 case(1.82%)in the observation group and 1 case(2.00%)in the control group.There was no marked difference between the two groups(P > 0.05).Within 90 days of treatment,the total number of adverse reactions in the observation group was 2(3.64%)and that in the control group was 2(4.00%).There was no marked difference between the two groups(P > 0.05).Conclusions:For patients with acute ischemic stroke whose NIHSS score is less than 15,the effect of intensive antiplatelet therapy with aspirin combined with clopidogrel on improving neurological deficit in the short term after stroke is significantly better than those with aspirin alone.It is also better than using aspirin alone in reducing the risk of recurrent ischemic stroke within 90 days.There was no significant difference in bleeding risk between the intensive antiplatelet group and the aspirin monotherapy group.