探討腦中風復發病人使用單抗血小板藥物與雙抗血小板藥物在3個月內復發率與出血風險之安全性

Comparison of the Effect of Single Versus Dual Antiplatelet Treatment on the Recurrence and Bleeding Risk for Patients after a Second Stroke

抗血小板製劑（Aspirin）臨床使用於缺血性中風次級預防，本研究目的為觀察單一抗血小板製劑與雙劑抗血小板製劑（以下簡稱單抗與雙抗）於再中風患者3個月內中風發生率及出血風險。本研究的方法以描述性統計、卡方檢定、重複測量ANOVA及t檢定分析，觀察兩組用藥情形、出血風險差異，收案期間108年1月31日至108年8月9日，共收得69位，扣除流失個案，共56位納入研究，研究結果顯示單抗與雙抗於研究期間未發生再中風，腸胃出血率8.9%（5人），外傷性顱內出血1.8%（1人），在兩組間無顯著差異;腸胃出血者有較高之肝功能檢測GOT，GPT值（SGOT: serum glutamic oxaloacetic transaminase（天冬氨酸氨基轉移酶），SGPT: Serum glutamate pyruvate transaminase（丙氨酸轉氨酶））及HAS-BLED大於3分之比率。本研究的結論為單抗與雙抗兩種使用方式在出血風險方面及預防再中風之效果於3個月內無顯著差異，HAS-BLED分數與實驗室檢查項目GOT，GPT肝功能檢測於腸胃出血之預測具敏感性。

In clinical practice, a standard intervention uses anti-platelet agents (Aspirin) to prevent the recurrence of an ischemic stroke. The study compares dual antiplatelet therapy withs monotherapy to prevent recurrent strokes, including the effect of treatment effect and risk. A prospective, repeated measures design is used. Fifty-six subjects receiving either single or dual antiplatelet therapy were followed up for 90 days. Monthly measurements included the HAS BLED score and laboratory data. Descriptive statistics, a Chi-square test, a repeated measures ANOVA & t-test analysis are used to distinguish between these two groups.
The results of this study show that there is no recurrent stroke during the period of observation. The gastrointestinal bleeding rate is 8.9% (5 persons), the traumatic intracranial hemorrhage is 1.8% (1 person) and the difference between the two groups is not significant. The assessment data shows that patients with higher GOT and GPT values for liver function and a HAS-BLED score of more than 3 have a high risk of bleeding.
There is no significant difference in the prevention of recurrent stroke and bleeding risk between the dual antiplatelet therapy and the monotherapy group. The GOT and GPT level for liver function and the HAS-BLED score are sensitive predictors for GI bleeding.