| Objective:To observe and evaluate the clinical efficacy and safety of aspirin and clopidogrel compare with aspirin and low molecular weight heparin(LMWH)sodium in the treatment of acute posterior circulation infarction caused by large artery stenosis.Methods:A total of 160 cases(100 male and 60 female)with cerebral infarction occurred for the first time and diagnosed with acute posterior circulation cerebral infarction by craniocerebral MRI and head and neck CTA to determine the damage location and the location of the artery stenosis were collected between April 2018 and March 2019 in the department of neurology in our hospital,and randomly divided into 2 groups: The control group included 80 cases(aspirin and clopidogrel,po)and the experimental group included 80 patients(aspirin and low molecular weight heparin sodium injection).After2 weeks,the treatment method of the experimental group changed to the same as the control group.The treatment of both groups lasted for 90 days.The NIHSS score was assessed before the treatment,and at 7 d,and at 14 d after treatment to determine the damaged degree of neurologic function.Watch out the changes of coagulation function,and recorded the symptomatic intracranial bleeding and other bleeding complications related to whole body organs.Follow-up of 90 days,assess the mRS and ADL of both groups,and any related adverse events.Results:There were 160 patients collected in the two groups,including 52 males and 28 females in the control group,with average age of 61.5±10.7;and in the experiment group,there were 48 males and 32 females,with average age of 60.2±11.3.The ages was no statistically significant difference between the two groups(P>0.05).Atherosclerosis related risk factors,especially hypertension and hyperlipidemia,accounted for the most in both two groups.Dizziness/vertigo and limb weakness were the commonest manifestation among the clinical symptoms.Among the clinical signs,positive pathological signs and dysarthria were high.However,all of these were no significant differences between the two groups(P>0.05).The most common occlusive vessels were vertebral artery and basilar artery,including the vertebral artery origin and intracranial vertebral artery.Multiple stenosis was more common in vertebral artery and base artery.There was no statistical difference in posterior vascular stenosis between the two groups(P>0.05).The location of cerebral infarction is mainly in the cerebellum and brainstem,which is related to the lesion site of artery vessels.There was no significant difference in NIHSS score between the two groups before treatment(P>0.05).The NIHSS score of patients in the control group at 7 days was lower than that before treatment,but there was no significant difference between this period.The NIHSS score of patients in the experiment group at 7days was significantly lower than that before treatment(P<0.05).After 14 days treatment,the NIHSS scores of patients in the control group and the experiment group were lower than those before the treatment(P<0.05).Compared with the control group,the NIHSS scores in the experiment group were lower than on the 7th and 14 th day after treatment(P<0.05).There was no significant difference in mRS score and ADL score between the two groups before treatment(P>0.05).After 90 days treatment,the mRS score of both the experiment group and the control group decreased and the ADL score increased significantly than before treatment(P<0.05).However,compared with the control group,the mRS score in the experiment group was significantly decreased(P<0.05).3 months after treatment,the proportion of mRS score in 0-2 points in the experiment group was significantly higher than that in the control group(P<0.05),while there was no significant difference in the proportion of 2-4 points and 4-6 points(P >0.05).This indicated that the experimental group could improve the prognosis of patients without increasing the proportion of poor prognosis.There were 2 bleeding events in the control group and 3bleeding events in the experiment group,but there was no significant difference in the incidence of bleeding events between the two groups(P>0.05).FIB,APTT and PT in the two groups were significantly different after 14 d of treatment(P<0.05).According to the relevant indicators in the laboratory,low molecular weight heparin anticoagulation combined with antiplatelet decreased FIB and prolonged APTT and PT,but this effect was related to the using time,the longer the time,the more obvious.Conclusion:The improvement of neurological function at 14 days and the prognosis of neurological function at 90 days in the treatment of acute post-circulatory cerebral infarction caused by arterial stenosis with aspirin combined with LMWH was better than that of aspirin combined with clopidogrel.Despite the prolongation of coagulation indexes,no symptomatic intracranial hemorrhage or bleeding events with poor prognosis were observed. |
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