大部分的腦中卒都源自腦部血管栓塞,。對于某些血液中有微栓子或是小的血凝塊的人而言，他們腦中卒發(fā)生幾率將升高很多,。

來自香港中文大學的Lawrence  Ka  Sing  Wong與研究團隊的人員合作進行的隨機臨床試驗發(fā)現(xiàn),，調(diào)查分析抗血凝藥作為中卒二次預(yù)防的臨床效果。研究結(jié)果顯示,，聯(lián)合用藥,，阿司匹林配合clopidogrel使用預(yù)防腦內(nèi)微小栓塞的效果比單獨使用阿司匹林的效果更加。

研究小組選用100名近期有中卒病史的患者進行追蹤調(diào)查,，其中47名患者接受雙重用藥試驗,，另外的53名患者接受單一用藥試驗，這是個為期7天的臨床試驗,。在試驗過程中,，第二天和第七天，所有患者接受顱部多普勒掃描，觀察腦部的微小栓塞信號,。

在第二天,，12名接受雙重用藥的病人和27名接受單一用藥的病人經(jīng)多普勒掃描發(fā)現(xiàn)有微小栓塞信號。在藥物副作用方面,，兩組病人所表現(xiàn)的結(jié)果是相似的,，只有2個接受雙重用藥的患者有輕微的出血現(xiàn)象。

這些研究結(jié)果表明,，雙重用藥是一種更為有效減輕栓塞,，預(yù)防二次中風的有效辦法。研究小組下一步的研究計劃是,，分析計算雙重用藥方式降低中風幾率的具體百分數(shù),。(生物谷Bioon.com)

Cell：中風的發(fā)病機制

生物谷推薦原文出處：

The Lancet Neurology doi:10.1016/S1474-4422(10)70060-0

Clopidogrel plus aspirin versus aspirin alone for reducing embolisation in patients with acute symptomatic cerebral or carotid artery stenosis (CLAIR study): a randomised, open-label, blinded-endpoint trial
Ka Sing Lawrence Wong FRCP a , Christopher Chen FRCP b, Jianhui Fu MD c, Hui Meng Chang FRCP d, Nijasri C Suwanwela MD e, Yining N Huang MD f, Zhao Han MD g, Kay Sin Tan FRCP h, Disya Ratanakorn MD i, Pavithra Chollate MD j, Yudong Zhao PhD j, Angeline Koh BHSc j, Qing Hao MD a, Hugh S Markus FRCP k, for the CLAIR study investigators

Background

Few randomised clinical trials have investigated the use of antithrombotic drugs for early secondary prevention of stroke or transient ischaemic attack in patients with intracranial atherosclerotic stenosis. Microembolic signals, detected by transcranial doppler, are a surrogate marker of future stroke risk and have been used to show treatment efficacy in patients with extracranial carotid stenosis. We aimed to investigate whether treatment with clopidogrel plus aspirin reduced the number of microembolic signals detected with transcranial doppler ultrasound compared with aspirin alone in patients with recent stroke.
Methods

The clopidogrel plus aspirin for infarction reduction in acute stroke or transient ischaemic attack patients with large artery stenosis and microembolic signals (CLAIR) trial was a randomised, open-label, blinded-endpoint trial. Between Oct 28, 2003, and Nov 19, 2008, patients with acute ischaemic stroke or transient ischaemic attack who had symptomatic large artery stenosis in the cerebral or carotid arteries and in whom microembolic signals were present on transcranial doppler were randomly assigned within 7 days of symptom onset to receive clopidogrel (300 mg for the first day, then 75 mg daily) plus aspirin (75—160 mg daily) or aspirin alone (75—160 mg daily) for 7 days. Patients were randomly assigned in blocks of four or six by use of a randomisation website. Monitoring of microembolic signals on transcranial doppler was done on days 2 and 7. The primary endpoint was the proportion of patients who had microembolic signals on day 2. Analysis was by modified intention to treat. All analyses were done by an investigator masked to both patient identity and the day the recording was taken. This trial is registered with the Centre for Clinical Trials, Chinese University of Hong Kong, number CUHK_CCT00164.
Findings

100 patients were randomly assigned to clopidogrel plus aspirin (n=47) or aspirin monotherapy (n=53). 93 of 100 patients had symptomatic intracranial stenosis in either the intracranial internal carotid artery or the middle cerebral artery: 45 of 46 in the dual therapy group and 48 of 52 in the monotherapy group. At day 2, 14 of 45 patients in the dual therapy group and 27 of 50 patients in the monotherapy group for whom data were available had at least one microembolic signal on transcranial doppler (relative risk reduction 42·4%, 95% CI 4·6—65·2; p=0·025). Adverse events were similar in the two groups. No patients had intracranial or severe systemic haemorrhage, but two patients in the dual therapy group had minor haemorrhages.
Interpretation

Combination therapy with clopidogrel and aspirin is more effective than aspirin alone in reducing microembolic signals in patients with predominantly intracranial symptomatic stenosis. Clinical trials are now warranted to investigate whether this combination treatment also results in a reduction in stroke incidence.