缺血性脑卒中系由各种原因所致的局部脑组织区域血液供应障碍,导致脑组织缺血缺氧性病变坏死,进而产生临床上对应的神经功能缺失表现,严重影响着患者的生存质量。抗血小板治疗能够降低缺血性脑卒中的早期复发率、早期死亡率,并能改善患者长期预后。本文将对缺血性脑卒中常用抗血小板药物的作用机制及药物特征进行综述。
Ischemic stroke is caused by various causes of regional blood supply disorders in brain tissue, resulting in ischemic hypoxic lesions necrosis of brain tissue, and then produce clinical corresponding neurological deficit manifestations, seriously affecting the quality of life of patients. Antiplatelet therapy can reduce the early recurrence rate, early mortality rate and improve the long-term prognosis of patients with ischemic stroke. This article will review the mechanism and characteristics of commonly used antiplatelet drugs in ischemic stroke.
高喜斌,康乐乐,高学军. 抗血小板治疗在缺血性脑卒中的研究进展Progress of Antiplatelet Therapy in Ischemic Stroke[J]. 临床医学进展, 2020, 10(07): 1531-1536. https://doi.org/10.12677/ACM.2020.107229
参考文献ReferencesBielewicz, J., Kurzepa, J., Lagowska-Lenard, M., et al. (2010) The Novel Views on the Pathomechanism of Ischemic Stroke. Wiadomosci Lekarskie, 63, 213-220.Li, Y. (2010) To Prevent and Treat Stroke Completely and Systematically and Reduce Its Damages. Shanghai Medical Journal, 9, 793-794.Wang, H. and Cai, H. (2015) The Clinical Curative Effect Observation of Treating Acute Cerebral Infarction in the Very Early Stage with Acupuncture. Journal of Clinical Acupuncture and Moxibustion, 3, 31-32.Murray, C.J. and Lopez, A.D. (2013) Measuring the Global Burden of Disease. The New England Journal of Medicine, 369, 448-457. <br>https://doi.org/10.1056/NEJMra1201534Yu, C., Luo, L., Li, M., et al. (2016) To Observe the Heavy Burden of Stroke in China from the View of the World. J Public Health Prev Med, 1, 1-5.Liu, S. (2007) Analysis about the Effects of Treating Stroke with Hyperbaric Oxygen and the Related Sequela. Chinese Journal of Practical Internal Medicine, S1, 256-267.Zhao, Y. (2011) Analysis about Prevention Measures for Stroke. Chinese Journal of Practical Nervous Diseases, 1, 52-53.Gong, L. (2005) The Recent Situation of Researches about the Young Stroke. China Med Abstr., 2, 237-239.Yang, G., Wang, Y., Zeng, Y., et al. (2013) Rapid Health Transition in China, 1990-2010: Findings from the Global Burden of Disease Study 2010. The Lancet, 381, 1987-2015. <br>https://doi.org/10.1016/S0140-6736(13)61097-1Ministry of Health of the PRC (2008) The Main Conditions of the Third Time National Death Inquiry. China Cancer, 5, 344-345.Wang, Y., Wu, S., Gao, J., et al. (2012) The Influence of Ideal Cardiovascular Healthy Behaviors and Factors for New Ischemic Stroke. Chinese Journal of Hypertension, 4, 342-346.Sandercock, P.A., Counsell, C., Tseng, M.C. and Cecconi, E. (2014) Oral Antiplatelet Therapy for Acute Ischaemic Stroke. Cochrane Database of Systematic Reviews, 3, CD000029. <br>https://doi.org/10.1002/14651858.CD000029.pub3Rothwell, P.M., Algra, A., Chen, Z., et al. (2016) Effects of Aspirin on Risk and Severity of Early Recurrent Stroke after Transient Ischaemic Attack and Ischaemic Stroke: Time-Course Analysis of Randomised Trials. The Lancet, 388, 365. <br>https://doi.org/10.1016/S0140-6736(16)30468-8中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组. 中国急性缺血性脑卒中诊治指南2018[J]. 中华神经科杂志, 2018, 51(9): 666-682.Laine, M., Paganelli, F. and Bonello, L. (2016) P2Y12-ADP Receptor Antagonists: Days of Future and Past. World Journal of Cardiology, 8, 327. <br>https://doi.org/10.4330/wjc.v8.i5.327Scott, S.A., Sangkuhl, K., Gardner, E.E., et al. (2011) Clinical Pharmacogenetics Implementation Consortium Guidelines for Cytochrome P450-2C19 (CYP2C19) Genoty Peandclopidogrel Therapy. Clinical Pharmacology & Therapeutics, 90, 328-332. <br>https://doi.org/10.1038/clpt.2011.132Meschia, J.F., Bushnell, C., Boden-Albala, B., et al. (2014) Guidelines for the Primary Prevention of Stroke: A Statement for Healthcare Professionals from the American Heart Association/American Stroke Association. Stroke, 45, 3754-3832. <br>https://doi.org/10.1161/STR.0000000000000046Lee, M., Saver, J.L., Hong, K.S., et al. (2013) Risk-Benefit Profile of Long-Term Dual- versus Single-Antiplatelet Therapy among Patients with Ischemic Stroke: A Systematic Review and Meta-Analysis. Annals of Internal Medicine, 159, 463-470. <br>https://doi.org/10.7326/0003-4819-159-7-201310010-00006Kernan, W.N., Ovbiagele, B., Black, H.R., et al. (2014) Guidelines for the Prevention of Stroke in Patients with Stroke and Transient Ischemic Attack: A Guideline for Healthcare Professionals from the American Heart Association/American Stroke Association. Stroke, 45, 2160-2236. <br>https://doi.org/10.1161/STR.0000000000000024Jia, D.M., Chen, Z.B., Zhang, M.J., et al. (2013) CYP2C19 Polymorphisms and Antiplatelet Effects of Clopidogrel in Acute Ischemic Stroke in China. Stroke, 44, 1717-1719. <br>https://doi.org/10.1161/STROKEAHA.113.000823Gu, S., Sun, Y., Han, R., et al. (2014) Association between Genetic Polymorphisms of Cytochrome P450 2C19 and the Risk of Cerebral Ischemic Stroke in Chinese. BMC Medical Genetics, 15, 83. <br>https://doi.org/10.1186/1471-2350-15-83Serebruany, V.L., Steinhubl, S.R., Berger, P.B., et al. (2005) Analysis of Risk of Bleeding Complications after Different Doses of Aspirin in 192,036 Patients Enrolled in 31 Randomized Controlled Trials. American Journal of Cardiology, 95, 1218. <br>https://doi.org/10.1016/j.amjcard.2005.01.049Lansberg, M.G., O’Donnell, M.J., Khatri, P., et al. (2012) Antithrombotic and Thrombolytic Therapy for Ischemic Stroke: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed.: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest, 141, e601S. <br>https://doi.org/10.1378/chest.141.4.1129b(2014) Prevention of Stroke in Patients with Stroke and Transient Ischemic Attack: A Guideline for Healthcare Professionals from the American Heart Association/American Stroke Association. Stroke, 45, 2160.
<br>https://doi.org/10.1161/STR.0000000000000024Greving, J.P., Diener, H.C., Reitsma, J.B., et al. (2019) Antiplatelet Therapy after Noncardioembolic Stroke. Stroke, 50, 1812. <br>https://doi.org/10.1161/STROKEAHA.118.024497Halkes, P.H., Gray, L.J., Bath, P.M., et al. (2008) Dipyridamole plus Aspirin versus Aspirin Alone in Secondary Prevention after TIA Orstroke: A Meta-Analysis by Risk. Journal of Neurology, Neurosurgery and Psychiatry, 79, 1218- 1223. <br>https://doi.org/10.1136/jnnp.2008.143875Diener, H.C., Cunha, L., Forbes, C., et al. (1996) European Stroke Prevention Study. 2. Dipyridamole and Acetylsalicylic Acid in the Secondary Prevention of Stroke. Journal of the Neurological Sciences, 14, 1-13.
<br>https://doi.org/10.1016/S0022-510X(96)00308-5Halkes, P.H., van Gijn, J., Kappelle, L.J., et al. (2006) Aspirin plus Dipyridamole versus Aspirin Alone after Cerebral Ischaemia of Arterial Origin (ESPRIT): Randomised Controlled Trial. The Lancet, 367, 1665-1673.
<br>https://doi.org/10.1016/S0140-6736(06)68734-5Foster, C.J., Prosser, D.M., Agans, J.M., et al. (2001) Molecular Identification and Characterization of the Platelet ADP Receptor Targeted by Thienopyridine Antithrombotic Drugs. Journal of Clinical Investigation, 107, 1591.
<br>https://doi.org/10.1172/JCI12242Cattaneo, M., Schulz, R. and Nylander, S. (2014) Adenosine-Mediated Effects of Ticagrelor: Evidence and Potential Clinical Relevance. Journal of the American College of Cardiology, 63, 2503-2509.
<br>https://doi.org/10.1016/j.jacc.2014.03.031Yamauchi, K., Imai, T., Shimazawa, M., et al. (2017) Effects of Ticagrelor in Amouse Model of Ischemic Stroke. Scientific Reports, 7, Article No. 12088. <br>https://doi.org/10.1038/s41598-017-12205-wAmarenco, P., Albers, G.W., Denison, H., et al. (2017) Efficacy and Safety of Ticagrelor versus Aspirin in Acute Stroke or Transient Ischaemic Attack of Atherosclerotic Origin: A Subgroup Analysis of SOCRATES, a Randomised, Double-Blind, Controlled Trial. The Lancet Neurology, 16, 301-310. <br>https://doi.org/10.1016/S1474-4422(17)30038-8Malhotra, K., Goyal, N. and Tsivgoulis, G. (2017) Internal Carotid Artery Occlusion: Pathophysiology, Diagnosis, and Management. Current Atherosclerosis Reports, 19, 41. <br>https://doi.org/10.1007/s11883-017-0677-7Powers, W.J., Rabinstein, A.A., Ackerson, T., et al. (2018) 2018 Guidelines for the Early Management of Patients with Acute Ischemic Stroke: A Guideline for Healthcare Professionals from the American Heart Association/American Stroke Association. Stroke, 49, e46-e110.Johnston, S.C., Amarenco, P., Albers, G.W., et al. (2016) Ticagrelor versus Aspirin in Acute Stroke or Transient Ischemic Attack. The New England Journal of Medicine, 375, 35-43. <br>https://doi.org/10.1056/NEJMoa1603060Konark, M., Nitin, G., Alissa, S., et al. (2018) Ticagrelor for Stroke Prevention in Patients with Vascular Risk Factors: A Systematic Review and Meta-Analysis. Journal of the Neurological Sciences, 390, 212-218.
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