Comparison of Antiplatelet and Antithrombotic Therapy for Secondary Prevention of Ischemic Stroke in Patients With Peripheral Artery Disease : – Population-Based Follow-up Study in Taiwan –
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概要
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Background: A limited number of studies have assessed the benefit and risk among the different antiplatelet and antithrombotic therapies in patient with stroke and peripheral artery disease (PAD). We compared the efficacy and safety of clopidogrel, cilostazol, warfarin, and aspirin. Methods and Results: A retrospective cohort study analyzing the Taiwan National Health Insurance Research Dataset identified patients with stroke and PAD from 2002 to 2008. Patients were stratified according to their use of aspirin, clopidogrel, cilostazol, warfarin or combination therapy. A total of 1,686 patients were enrolled: aspirin (n=862), clopidogrel (n=92), warfarin (n=136), cilostazol only (n=515), and cilostazol-based combination therapy (n=81). Compared with aspirin, cilostazol could reduce the risk of ischemic stroke [hazard ratio (HR) 0.79, 95% confidence interval (CI) 0.63–0.98, P=0.0349) and no increase in hemorrhagic events (HR 0.98, 95% CI 0.74–1.32, P=0.9122). Clopidogrel decreased the risk of ischemic stroke (HR 0.47, 95% CI 0.29–0.78, P=0.0033) and hemorrhagic events (HR 0.64, 95% CI 0.31–0.96, P=0.034) more than aspirin. There was no statistical difference regarding the risk of stroke and hemorrhagic events among warfarin, cilostazol-based combination therapy and aspirin. Conclusions: Cilostazol and clopidogrel were more effective in preventing recurrent ischemic stroke without increased hemorrhagic events than aspirin in patients with PAD.
著者
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Su Ho-ming
Department Of Internal Medicine Kaohsiung Municipal Hsiao-kang Hospital Kaohsiung Medical University
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SHEU Sheng-Hsiung
Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital
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Lin Tsung-Hsien
Department of Internal Medicine, College of Medicine, Kaohsiung Medical University
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Voon Wen-Chol
Department of Internal Medicine, College of Medicine, Kaohsiung Medical University
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Lai Wen-Ter
Department of Internal Medicine, College of Medicine, Kaohsiung Medical University
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Sheu Sheng-hsiung
Division Of Cardiology Department Of Internal Medicine Kaohsiung Medical University Hospital
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Hsu Po-chao
Division Of Cardiology Department Of Internal Medicine
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Voon Wen-Chol
Department of Internal Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University
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Chu Chun-Yuan
Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital
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Lee Wen-Hsien
Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital
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Su Ho-Ming
Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital
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Lin Tsung-Hsien
Department of Internal Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University
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