Clinical Research About Combining Low-Dose Aspirin With Ticlopidine, Dipyridamole And Yinxingyepian In Treatment And Prevention Of Ischeamic Cerebral Stroke

Objective To observe the clinical therapeutic effectiveness and safety about combining Aspirin with Ticlopidine,Dipyridamole and Yinxingyepian respectively in the treatment and prevention of cerebral ischemic stroke .Methods 1. The criterion choiced were :According to the criterion of clinical neurological function damaged count of patients with cerebral ischemic stroke established by the 4th national congress of CVD, 360 patients with acute ischemic cerebral stroke cluding lighter and medium type .All patients fit for the acute cerebral vascular disease classification criterion and diaognose mainpoint established by the 4th national congress of CVD and were proved by CT or MR. Age: was among the 45-70 years, the average age was 56.43 ± 12.67 years;Sex: mail was 176 cases ,femail was 184 cases;the lighter type was 232 cases, the medium type was 128 cases. The neurological system function deficit score was 8-28, the average score was 16.44 ± 4.31.2. The criterion abandoned were :(1).Age was <45 or >70years;(2).The patients with the clinical evidence of serious damage of liver and kidney. (3). The patients with the recently active digestive ulcer, bleeding of all body. (4). The patients with the blood system diseases and bleeding or clotting function disorder. (5). The patients were carried out the wound checken and large surgery . (6). The patients had the therapeutic forbiddion of Aspirin ,Ticlopidine, Dipyridamole, Yinxingyepian. According to the time ofexamination or hospitalization, the patients were randomly divided into four groups: low-dose Aspirin group, low-dose Aspirin with Ticlopidine group, low-dose Aspirin with Dipyridamole group and low-dose Aspilin with Yinxingyepian group. There were 90 patients in each group. There were 350 patients finished the trial in end.Treatment methods and index: Each patient was given Aspirin 150mg at first within 24 to 48 hours after the onset of ischemic cerebral stroke,after that they were given 75mg,qn. Based on this treatment, the second group was given Ticlopidine 0.25 qd;the third group was given Dipyridamole 50mg tid, the fourth group was given -Yinxingyepian. 2 tablets tid respectively. They were forbidden to take any other antiplatelet drugs. Before treatment and the 28th day after treatment and the time of the trial ended, they were examined blood routine, platelet number, platelet volum, platelet distribution width, the weight of thrombrosis, the adhesiveness of platelet and aggregation of platelet, rheological index, the function of liver and kidney, stool occult test. We carried out the neurological system function deficit score(NFD) evaluation.Acording to the neurological system function deficit score, we evaluated the clinical therapeuticness. We also observed that if there were vice-effect..They can also be used in the secondary prevention of ischemic cerebral stroke.. Each patient was followed up once in one or two months and lasted for 6 months, the ended points were cerebral infarction re-attack, myocardial infarction re-attack.or death. We observed the effect of prevention about low-dose Aspirin, low-dose Aspilin with Ticlopidine, Dipyridamole ,Yinxingyepian. respectively.and carried out medical statistics .Result During the acute time ,the platelet number of patients of four groups were increased obviously. The platelet volume,.platelet adhesive rate and platelet aggregative rate patients of four groups were lower than befor treatment . this had significantly medical statistics(p<0.01) .There were no significant medical statistics in the ASA+TIC group,ASA+DA group andASA+YXYP group (p>0.05).The clinical therapiticness of four groups on the 28th after treatment were: .The total therapitic efficiencal rate and the obvious therapitic efficiencal rate of the low-dose Aspilin group , low-dose Aspilin with Ticlopidine group, low-dose Aspilin with Dipyridamole group and low-dose Aspilin with Yinxingyepian group were 81.82% (72/88)and 47.73%(42/88) , 90.69(78/86)%and 58.13%(50/86), 90.80%(79/87)and 54.02%(47/87)and 91.01%(81/89), 57.30%(51/89) respectively. There were significant difference between Aspilin group and the other three groups ( x2=10.42,P<0.05) . But there was no-significant difference amonge the other three grougs( x2=10.42, P>0.05). The prevalence for cerebral infarction or myocardial infarction of the ASA group , the ASA+TIC group, the ASA+DA group, the ASA+YXYP group on the 28th after treatment were 4.55%(4/88), 1.16% (1/86) , 2.30%(2/87) and 1.12%(l/89) respectively. There were significant difference between Aspilin group and the other three groups( P <0.01).The final events of the four groups at the ended point for followed up: the four groups incidence ratio of final events were 13.63%, 6.98%, 8.05% and 7.87% respectively. The prevalence for Ischaemic stroke in the ASA group, ASA+TIC group, ASA+DA group, ASA+ YXYP group 7.95%, 1.16%, 5.75%, and 3.37% respectively. The prevalence for HIC in the ASA group, ASA+TIC group ,ASA+DA group ,ASA+ YXYP group were 1.14%, 4.65%, 1.15% and 1.12% respectively. The prevalence for myocardial infarction in the ASA group ,ASA+TIC group ,ASA+DA group ,ASA+ YXYP group were 4.55%, 0, 1.15% and 1.12% respectively. Stroke and death-risk in the three groups were lower than that in ASA group (p<0.05). The prevalence for Ischaemic stroke or myocardial infarction in the ASA+TIC group,in the ASA+DA group, in the ASA+ YXYP group was lower than in Aspilin group (p<0.01).The risk of IS, myocardial infarction reduced 85.83%, 27.80% ,57.61% and 100%, 74.73%, 44.44% respectively. There was certain side effect in taking ASA ,TIC, DA and YXYP for long term. Total prevalenceof side-effect of the foue groups were 7.85%, 11.63%, 10.34% and 6.74% respectively during trial. The side effect of ASA+TIC group is higher than other groups . there was significant difference between the four groups (P<0.05).Conclusion Therapeutic effectivenees for the prevention IS or IM of being used combining low-dose Aspirin with Ticlopidine, Dipyridamole Yinxingyepian respectively was better than being used low-dose aspilin. There was no obvious difference between the incidence of the side effects among the four groups, low-dose aspilin combining with Ticlopidine Dipyridamole, Yinxingyepian,could be the fiest-line drugs for treatment and prevention ischaemic cerebral stroke.and myocardial infarction. The low-dose aspilin combining with Ticlopidine has the higher risk of Intracerebral hemorrhage and side effect than the other three droups.