反覆腸胃道出血且非心因性缺血性腦中風個案預防再中風之抗血小板藥物選擇：個案報告

Selection of Antiplatelet Drugs for Preventing Recurrent Stroke in Non-cardiogenic Ischemic Stroke with Recurrent Gastrointestinal Bleeding: A Case Report

腦中風的發生率在臺灣每十萬人約300至500人，其中缺血性腦中風約佔74%。預防再次缺血性腦中風以抗血小板藥物為主，常見的藥物包括aspirin及clopidogrel，但有些病人使用後會增加出血的風險甚至出現危及生命的嚴重出血副作用，因此要如何達到最大的淨效益(net benefit)是一個重要的課題。此篇病例報告呈現一位需使用抗血小板藥物預防再次缺血性腦中風但併有反覆腸胃道出血的個案，在無法忍受使用aspirin或clopidogrel的情況下，以實證醫學為基礎選擇cilostazol當作預防再次缺血性腦中風之抗血小板藥物，後續追蹤至今約一年，個案無再次發生腸胃道出血及再中風之情形。

 

In Taiwan, the incidence rate of stroke is approximately 300 to 500 per 100,000 people, with ischemic stroke accounting for approximately 74% of the cases. Antiplatelet medications, especially aspirin and clopidogrel, are commonly used to prevent recurrent ischemic stroke but may increase the risk of bleeding, even potentially life-threatening severe bleeding, in some patients. Therefore, achieving the maximum net benefit is an important issue. This case report presents a patient who required antiplatelet medication for preventing recurrent ischemic stroke but experienced repeated gastrointestinal bleeding. Unable to tolerate aspirin or clopidogrel, the patient was prescribed cilostazol for the prevention of recurrent ischemic stroke. Follow-up for approximately one year found no recurrence of gastrointestinal bleeding or stroke in this case.