Abstract：
Antiplatelet therapy is one of the mainstays for secondary stroke prevention. This narrative review aimed to highlight the current evidence and recommendations of antiplatelet therapy for stroke prevention.We conducted advanced literature search for antiplatelet therapy. Landmark studies and randomised controlled trials evaluating antiplatelet therapy for secondary stroke prevention are reviewed. Results from Cochrane systematic review, pooled data analysis and meta-analysis are discussed.Single-antiplatelet therapy (SAPT) with aspirin, aspirin/extended-release dipyridamole or clopidogrel reduces the risk of recurrent ischaemic stroke in patients with non-cardioembolic ischaemic stroke or transient ischaemic attack (TIA). Dual-antiplatelet therapy (DAPT) with aspirin and clopidogrel or ticagrelor for 21-30 days is more effective than SAPT in patients with minor acute noncardioembolic ischaemic stroke or high-risk TIA. Prolonged use of DAPT is associated with higher risk of haemorrhage without reduction in stroke recurrence than SAPT. Compared with placebo, aspirin reduces the relative risk of recurrent stroke by approximately 22%. Aspirin/dipyridamole and cilostazol are superior to aspirin but associated with significant side effects. Cilostazol or ticagrelor might be more effective than aspirin or clopidogrel in patients with intracranial stenosis.SAPT is indicated for secondary stroke prevention in patients with non-cardioembolic ischaemic stroke or TIA. DAPT with aspirin and clopidogrel or ticagrelor for 21-30 days followed by SAPT is recommended for patients with minor acute noncardioembolic stroke or high-risk TIA. Selection of appropriate antiplatelet therapy should also be based on compliance, drug tolerance or resistance.
摘要：
抗血小板治疗是中风二级预防的主要手段之一。这篇叙述性综述旨在强调抗血小板治疗预防中风的当前证据和建议。我们进行了抗血小板治疗的高级文献检索。综述了评价抗血小板治疗用于二级卒中预防的标志性研究和随机对照试验。Cochrane系统评价结果，讨论了汇总数据分析和荟萃分析。单一抗血小板治疗（SAPT）与阿司匹林，阿司匹林/缓释双嘧达莫或氯吡格雷可降低非心源性缺血性卒中或短暂性脑缺血发作(TIA)患者复发性缺血性卒中的风险.在轻度急性非心源性缺血性卒中或高危TIA患者中，使用阿司匹林和氯吡格雷或替格瑞洛进行21-30天的双重抗血小板治疗（DAPT）比SAPT更有效。与SAPT相比，长期使用DAPT与更高的出血风险相关，而不会减少中风复发。与安慰剂相比，阿司匹林可使卒中复发的相对风险降低约22%.阿司匹林/双嘧达莫和西洛他唑优于阿司匹林，但伴有明显的副作用。对于颅内狭窄患者，西洛他唑或替格瑞洛可能比阿司匹林或氯吡格雷更有效。SAPT适用于非心源性缺血性卒中或TIA患者的二级卒中预防。对于轻度急性非心源性栓塞性卒中或高危TIA患者，建议使用阿司匹林和氯吡格雷或替格瑞洛进行DAPT治疗21-30天，然后进行SAPT。选择合适的抗血小板治疗也应基于依从性，药物耐受性或耐药性。
