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目的探讨抗血小板药物应用在伴有无症状脑梗死(SCI)的老年缺血性卒中患者中的安全性。方法对2010年7—12月中山大学附属第一医院60岁以上首次发病的缺血性卒中住院患者进行磁共振检查。入选磁共振上除责任病灶外伴有(A组)和不伴有SCI(B组)的患者,同时期入选60岁以上存在高血压和(或)糖尿病需进行缺血性脑血管病一级预防的SCI者(C组)。记录临床和影像学资料,同时给予抗血小板药物治疗以及其他标准防治措施,随访2年,比较出血性事件和死亡情况。结果随访完整的230例患者中共发生出血性事件27例,其中脑出血5例,胃肠道出血12例,皮肤黏膜出血10例,3组之间差异无统计学意义。167例使用阿司匹林,63例使用氯吡格雷,脑出血(2.40%对1.59%),胃肠道出血(5.39%对4.76%)和皮肤黏膜出血(4.79%对3.17%)的发生率在使用阿司匹林和氯吡格雷的患者中差别不大。但在存在SCI的患者中(A+C组)使用拜阿司匹林患者总体出血发生率高于氯吡格雷患者(12.5%对8.33%,P<0.05)。结论伴有SCI的缺血性卒中患者应用抗血小板治疗出血并发症未见明显增加,其中氯吡格雷可能安全性更高。
Objective To investigate the safety of antiplatelet drugs in elderly ischemic stroke patients with asymptomatic cerebral infarction (SCI). Methods Magnetic resonance imaging was performed on the first hospitalized patients with ischemic stroke over the age of 60 in the First Affiliated Hospital of Sun Yat-sen University from July to December in 2010. In addition to the selected patients with magnetic resonance lesions outside the associated (group A) and not associated with SCI (group B) patients over the same period included in the selection of hypertension and (or) over the age of 60 need to be ischemic cerebrovascular disease Prevention of SCI (C group). Clinical and radiographic data were recorded. Antiplatelet medications and other standard preventive and control measures were also given. Follow-up was 2 years and bleeding events and deaths were compared. Results Totally 27 cases of hemorrhagic events occurred in 230 patients with complete follow-up. There were 5 cases of cerebral hemorrhage, 12 cases of gastrointestinal bleeding and 10 cases of mucocutaneous bleeding. There was no significant difference among the 3 groups. The incidence of aspirin in 167 patients, clopidogrel in 63 patients, cerebral hemorrhage (2.40% vs 1.59%), gastrointestinal bleeding (5.39% vs 4.76%) and mucocutaneous bleeding (4.79% vs. 3.17% And no difference in patients with clopidogrel. However, patients in the presence of SCI (A + C group) had a higher rate of overall bleeding compared with clopidogrel in patients receiving aspirin (12.5% vs 8.33%, P <0.05). Conclusions There is no significant increase in the complication of bleeding with antiplatelet therapy in patients with ischemic stroke associated with SCI, and clopidogrel may be more safe.