雙重抗血小板藥物於輕度缺血性腦中風或短暫性腦缺血發作之治療

Dual Antiplatelet Therapy for Minor Ischemic Stroke or Transient Ischemic Attack

輕度缺血性腦中風或短暫性腦缺血發作之患者，再度發生缺血性腦中風的風險高達3－15％；因此，如何預防中風復發是一個重要的課題。單獨使用aspirin只能降低20％再中風風險，至於併用aspirin與clopidogrel這樣的雙重抗血小板藥物（雙抗）組合於這群病患的效益與安全性，在CHANCE與POINT這兩大臨床試驗中得到驗證。CHANCE試驗顯示，於輕度缺血性腦中風或短暫性腦缺血發作後使用雙抗組合治療21日，可有效降低再中風之風險，且並無增加出血風險。POINT試驗發現，於輕度缺血性腦中風或短暫性腦缺血發作後使用雙抗組合治療90日，雖然可以降低再中風之機率，但卻會顯著增加出血風險。這兩大試驗之結果證實了併用aspirin與clopidogrel於這群病患的益處，但也點出雙抗組合治療使用越久「則出血風險越高之現象。

For patients with minor ischemic stroke or transient ischemic attack (TIA), the risk of recurrent ischemic stroke is around 3-15%. Therefore, it is crucial about how to prevent recurrent stroke in these patients. Aspirin alone can only prevent around 20% of recurrent stroke, while the efficacy and safety of combined aspirin and clopidogrel in these patients has been studied in the CHANCE and POINT trials. CHANCE trial revealed that combined aspirin and clopidogrel for 21 days could significantly decrease the risk of ischemic stroke without increased bleeding risk. POINT trial showed that combined aspirin and clopidogrel for 90 days also could effectively decrease the risk of recurrent ischemic stroke, but could increase the risk of bleeding. The two important trials confirmed the benefits of dual antiplatelet therapy for the patients with minor ischemic stroke or TIA, but also indicated that longer duration of dual antiplatelet therapy was related to higher risk of bleeding events.