目的 对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、TheCochrane 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.%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 Metaanalysis 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.
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