Saftey And Efficacy Of Combination Antiplatelet Therapy Is Assessmented In The Acute Phase Of Progressive In Ischamic Stroke

Purpose:Objective to detect the safety and efficacy of combination antiplatelettherapy,assessmenting in the acute phase of progressive in ischamic strokeMethods:A total of301patients who sufferred from acute ischemiccerebrovascular disease were enrolled in the study from January2009to June2012inthe General Hospital of Shenyang Millitary Region, Acute ischemic stroke within72hours of onset were confirmed by CT or MRI.All the patients were admitted toNeurology department and monitored for neurologic deterioration (1or2scoreincrease in NIHSS). NIHSS was measured at the admission day，neurologicaldeteriorations and at day7after admission. The modified TOAST etiological type of281patients with acute cerebral infarction by Han proposed.20patients with transientischemic attack patients according to the ABCD2score of high, low stratification.Patients were randomly divided into loading dose group (the day after the first dose of300mg of clopidogrel, aspirin and clopidogrel instead combination) and the singledrug group (aspirin alone). In October2011to join in another group, combinationgroup (aspirin and clopidogrel combined). The loading dose group male116cases,female14cases, age36-86years old,an average of60.71±11.58; the combinationgroup male27cases, female10cases, age33-80years old, an average of61.72±11.55; single drug group male116cases, female18cases, age27-87years old, anaverage of61.01±12.25. Loading dose group was given oral clopidogrel loading dose300mg on the same day, the next day to75mg clopidogrel+100mg aspirin orallyonce a day, for2weeks; the single treatment group on the admission day takingaspirin300mg orally once a day, for2weeks; the combination group on admissionday75mg+aspirin clopidogrel100mg oral once a day, for2weeks.After2weeks,three groups were changed to routine preventive dose aspirin100mg orally once a day.Results:134cases of hospitalized patients with single drug treatment groupNIHSS score was3.25±2.40,2weeks after treatment NIHSS was1.96±2.16,compared before and after treatment was statistically significant (P <0.001);130cases of hospitalized patients with loading dose treatment group NIHSS score was3.95±2.81,2weeks after treatment NIHSS was2.22±2.36, before and after treatmentcompared with statistical significance (P <0.001);37cases of patients admitted tohospital combination treatment group NIHSS score was3.65±2.25,2weeks aftertreatment NIHSS was2.11±2.29, before and after treatment compared with statisticalsignificance (P <0.001). In20patients with TIA, aspirin group1case occurred stroke;36/281cases of cerebral infarction occurred progression in ischamic stroke, including26/134cases of single drug group and8/130cases of loading dose group and2/37cases of combination group. Single drug group82cases artery atheroscleroticcerebral infarction in patients occurred progress in23cases (28.05%), loading dosegroup of79cases of artery atherosclerotic cerebral infarction progress occurred in7cases (8.86%) and the combination group31cases of artery atherosclerosis in patientswith cerebral infarction progress occurred in2cases (6.45%). Security aspects: threegroups during treatment, nonfatal bleeding occurred in7cases, among them, theloading dose group of gingival bleeding in2cases, urinary tract bleeding in1case,skin mucous membrane bleeding in1case; Combination group of gingival bleedingin1case; Aspirin group of gingival bleeding in1case, skin mucous membrane1caseappeared. Are not occurred in the three groups of lethal gastrointestinal hemorrhageor intracranial hemorrhage, neither blood cell reduction, blood coagulationdysfunction, asthma, and other adverse reactions.Conclusion:1.For ischemic stroke or TIA patients were treated with acuteantiplatelet therapy after treatment, the scores of nervous function defect significantlyimproved;2. In the present study, within72hours after stroke and TIA loading dose of300mg of clopidogrel and aspirin is safe;3. For progressive ischemic cerebralinfarction, combined treatment with aspirin and clopidogrel is an acute period of safeand effective anti-platelet therapy, compared with single antiplatelet therapy, cansignificantly reduce the recurrence of stroke and progressive ischemic stroke incidence,especially the incidence of large artery atherosclerotic cerebral infarction.