阿司匹林联合氯吡格雷治疗IS/TIA致出血并发症的Meta分析

田方圆+吴斌+徐珽

[摘要] 目的 對阿司匹林联合氯吡格雷治疗缺血性脑卒中或短暂性脑缺血发作引发出血风险进行系统评价。 方法 以“缺血性脑卒中”“短暂性脑缺血发作”“阿司匹林”“氯吡格雷”为检索词，计算机检索PubMed、EMBase、The Cochrane Library、CBM、CNKI、VIP和WanFang Data，检索自建库截至2017年2月。由2位研究人员独立进行文献筛选、数据提取和质量评价后，采用RevMan 5.3软件进行Meta分析。 结果 共纳入15个研究，包括11 200例患者，Meta分析结果显示：治疗缺血性脑卒中时，联合用药增加消化道出血风险（OR = 2.18，95%CI：1.43～3.34，P = 0.0003）。治疗短暂性脑缺血发作/轻型卒中时，联合用药增加轻度出血风险（OR = 1.50，95%CI：1.10～2.04，P = 0.01）。 结论 基于当前证据，长时间应用阿司匹林和氯吡格雷联合治疗短暂性脑缺血发作时，会增加轻度出血风险，长时间联合应用两药治疗缺血性脑卒中时，会增加消化道出血风险。受纳入研究数量和质量的影响，上述结论尚需开展更多高质量研究予以证实。

[关键词] 缺血性脑卒中；短暂性脑缺血发作；出血并发症；阿司匹林；氯吡格雷

[中图分类号] R743.31 [文献标识码] A [文章编号] 1673-7210（2017）06（b）-0123-04

Bleeding complications caused by treatment of Aspirin and Clopidogrel for IS/TIA： a Meta-analysis

TIAN Fangyuan1，2 WU Bin1 XU Ting1

1.Department of Clinical Pharmacy， West China Hospital， Sichuan University， Sichuan Province， Chengdu 610041， China； 2.West China School of Pharmacy， Sichuan University， Sichuan Province， Chengdu 610041， China

[Abstract] Objective To systematically assess the bleeding complications caused by treatment of Aspirin and Clopidogrel for ischemic stroke or transient ischemic attack. Methods Taking "ischemic stroke"， "transient ischemic attack"， "Aspirin" and "Clopidogrel" as the search terms to search the database. Databases of PubMed， EMBase， The Cochrane Library， CBM， CNKI， VIP and WanFang Data were searched from inception to February 2017. Two reviewers independently screened literatures， extracted data and assessed quality of included studies. Then Meta-analysis was conducted by RevMan 5.3 software. Results A total of 15 studies involving 11 200 patients were included. The results of Meta-analysis showed that： during the treatment of ischemic stroke， drug combination could increase the risk of gastrointestinal bleeding （OR = 2.18， 95%CI： 1.43-3.34， P = 0.0003）； during the treatment of transient ischemic attack/light stroke， drug combination could increase the risk of mild bleeding （OR = 1.50， 95%CI： 1.10-2.04， P = 0.01）. Conclusion Based on current evidence， long term application of combination of Aspirin and Clopidogrel in the treatment of transient ischemic attack will increase the risk of mild bleeding， long term application of the two drugs in the treatment of ischemic stroke will increase the risk of gastrointestinal bleeding. Due to the impact of quantity and quality of the included studies， the conclusion above still needs carrying out more high-quality studies to confirm.

[Key words] Ischemic stroke； Transient ischemic attack； Bleeding complications； Aspirin； Clopidogrel

脑卒中已成为严重危害人类健康的疾病之一，据世界卫生组织（WHO）统计，其致死率和致残率高居我国第1位、全球第2位[1]。我国每年新发脑卒中病例约有200万，约有150万人死于脑血管病[2-3]。在临床上，缺血性脑卒中（即脑梗死）占所有脑卒中的80%左右[4]，短暂性脑缺血发作则被公认为脑梗死的第一预警信号，如未得到及时有效的治疗，1/3的患者可进展为缺血性脑卒中[5-6]。阿司匹林作为抗血小板药物是缺血性脑卒中和短暂性脑缺血患者预防和治疗中最常应用的药物[7]，但其临床获益有限[8]。……