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目的:探讨水蛭素合用阿司匹林治疗短暂性脑缺血发作(TIA)的疗效和安全性。方法:89例TIA患者随机分为3组:(1)氯吡格雷组(n=29),口服氯吡格雷75mg/d;(2)阿司匹林组(n=30),口服阿司匹林100mg/d;(3)水蛭素合用阿司匹林组(n=30),口服水蛭素0.32g,3次/d,阿司匹林100mg/d。观察治疗后90d内TIA复发或进展为脑梗死的病例数,观察出血等不良事件发生率。结果:治疗后90d内总的脑梗死发生率为4.5%,3组之间无显著差异。水蛭素合用阿司匹林组和氯吡格雷组90d内的TIA复发风险分别较单用阿司匹林降低69%(P=0.0078)和65%(P=0.0170)。总的出血发生率为2.25%,均发生在水蛭素合用阿司匹林组。结论:水蛭素合用阿司匹林可降低90d内TIA复发率的效果优于单用阿司匹林,与单用氯吡格雷相似,但出血风险增高。
Objective: To investigate the efficacy and safety of hirudin in combination with aspirin in the treatment of transient ischemic attack (TIA). Methods: A total of 89 patients with TIA were randomly divided into three groups: (1) clopidogrel group (n = 29), oral clopidogrel 75 mg / d, aspirin group (n = 30) and aspirin 100 mg / (3) Hirudin combination aspirin group (n = 30), oral hirudin 0.32g, 3 times / d, aspirin 100mg / d. The number of TIA relapse or progression to cerebral infarction within 90 days after treatment was observed, and the incidence of adverse events such as bleeding was observed. Results: The total incidence of cerebral infarction within 90 days after treatment was 4.5%. There was no significant difference between the three groups. The 90-day risk of TIA recurrence in hirudin combination aspirin group and clopidogrel group was 69% (P = 0.0078) and 65% (P = 0.0170) lower than that in aspirin alone group. The overall incidence of bleeding was 2.25%, all occurred in the combination of hirudin aspirin group. CONCLUSION: The combination of hirudin and aspirin can reduce the recurrence rate of TIA within 90 days better than aspirin, which is similar to clopidogrel alone, but the risk of bleeding is increased.