ࡾġġЕ ߨЖӰ‫ܒ‬ીՖ‫ܒ‬သϛॳ‫ת‬Ֆω‫ݖ‬᛾‫ݽސ‬ᕛࡾЕ

ijıijıѮᢊသϛॳᏰོߨЖӰ‫ܒ‬ીՖ‫ܒ‬သϛॳġ
‫ת‬Ֆω‫ݖ‬᛾‫ݽސ‬ᕛࡾЕ

ഋ࢙ᓄ 1*ǵഋ‫ ܸד‬2*ǵ෯Ⴈ։ 2ǵೱҥܴ 3ǵ஭‫ك‬Ԁ 4ǵ‫ߪ׵‬ੀ 5ǵቅ஖౺ 6ǵ

ഋѓጎ 7ǵഋᓪ 8ǵ݅໡ӵ 9ǵֺᅸ࣑ 10ǵᖴᙼ໚ 11ǵᗛ߀๩ 12ǵᎄࡌᑫ 2ǵ
ߚЈӢ‫܄‬લՈ‫܄‬တύ॥‫ל‬Ոλ݈ᛰ‫ݯނ‬ᕍࡰЇӅ᛽λಔ
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Ѡύᄪ҇ᕴᙴଣઓ࿶ᙴᏢύЈတύ॥ύЈ
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Ѡεᙴଣઓ࿶೽ᄤတύ॥ύЈ
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ཥӀֆОྰइ‫ۺ‬ᙴଣઓ࿶ࣽ
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ଯ໢ߏ۪इ‫ۺ‬ᙴଣઓ࿶ϣࣽ೽တՈᆅࣽ
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Οैᕴᙴଣઓ࿶ࣽ೽
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ύ୯ᙴᛰεᏢߕ೛ᙴଣઓ࿶೽
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ᖄཥ୯ሞᙴଣύ॥ᙴᕍύЈ
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ᆵчᙴᏢεᏢᙴᏢଣᙴᏢ‫س‬ᄤ೽ҥᚈ‫ک‬ᙴଣઓ࿶ࣽ
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ଭିइ‫ۺ‬ᙴଣઓ࿶ࣽ
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ԋεᙴଣઓ࿶೽
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Ѡࠄཥኴᙴଣઓ࿶ϣࣽ
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Ѡчᄪ҇ᕴᙴଣઓ࿶ᙴᏢύЈઓ࿶ϣࣽ

IJįġġߨ ЖӰ‫ܒ‬ીՖ‫ܒ‬သϛॳ‫ܖ‬ aspirinˣclopidogrelˣcilostazolˣticlopidineˣ⍲

aspirinἝ䓐攟㓰✳dipyridamoleˤ
኷ਢ‫ܒ‬သીՖϞԩ઻Ⴑ٩
IJįijġłŴűŪųŪů
IJįIJġಛӫϷ‫ـंݙ‬ Aspirin䘬ἄ䓐ᷣ天㗗㈹⇞cyclooxygenase炻
ᶨᾳ⊭⏓287枭䞼䨞䘬䴙⎰↮㜸栗䣢炻㚦 ἧ埨⮷㜧䃉㱽䓇ㆸthromboxane A2 (TXA2)ˤ
䴻㚱仢埨⿏儎ᷕ桐ㆾ㙓㗪⿏儎仢埨(transient TXA2㚱⼰⻟䘬埨⮷㜧ↅ普冯埨䭉㓞䷖䘬ἄ
ischemic attack, TIA)䘬䕭Ṣ⛐㍍⍿㈿埨⮷㜧喍 䓐炻䔞TXA2䓇ㆸ塓㈹⇞㗪炻埨⮷㜧䘬ↅ普ḇ
䈑㱣䗪⼴炻♜慵䘬⽫埨䭉ḳẞ(⏓朆农␥䘬⽫倴 ⯙塓㈹⇞ˤAspirin䓐㕤儎ᷕ桐⽑䘤䘬枸旚炻䲬
㠿⠆ˣ朆农␥䘬儎ᷕ桐ㆾ埨䭉⿏㬣ṉ)ᷳ䘤䓇 ⎗㷃⮹15%䘬䚠⮵桐晒3-6ˤ晾䃞aspirinḇ㚫ṃ⽖
䌯䚠⮵㷃⮹忼25%烊䚠䔞㕤㭷㱣䗪1,000⎵㚦㚱 ⡆≈↢埨⿏儎ᷕ桐䘬桐晒炻Ữ㗗⎗ẍ栗叿㷃⮹
儎ᷕ桐ㆾTIA䘬䕭Ṣ忼2⸜炻⎗ẍ枸旚36㫉埨䭉 仢埨⿏儎ᷕ桐⽑䘤䘬桐晒炻⚈㬌㚫ⷞἮ栗叿䘬
ḳẞ炻℞㓰䙲怈崭忶栙⢾♜慵↢埨䘬䳽⮵桐晒 ䷥橼⤥嗽 7, 8ˤ䚜㍍㭼庫ᶵ⎴∹慷䘬䞼䨞䘤䎦炻
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ˤ⎎ᶨᾳ䴙⎰↮㜸炻ἧ䓐㈿埨⮷㜧喍䈑㱣䗪炻 㭷㖍∹慷⮷㕤75㮓⃳䘬aspirin⮵儎ᷕ桐⽑䘤䌯
儎ᷕ桐⽑䘤䘬䚠⮵桐晒傥㷃⮹13%⍲15%2ˤ䚖 䘬⼙枧冯⬱ㄘ∹㰺㚱ⶖ䔘1, 9炻侴㭷㖍∹慷325㮓
⇵㚱5ᾳ㈿埨⮷㜧喍䈑䴻⎘䀋梇⑩喍䈑䭉䎮会 ⃳䚠庫㕤81㮓⃳᷎ᶵ㚫㷃⮹㚜⣂䘬⽫埨䭉䕦䕭
(TFDA)㟠Ⅾἧ䓐⛐仢埨⿏儎ᷕ桐䘬㱣䗪炻⊭㊔ ḳẞ⽑䘤炻ᶼ㭷㖍∹慷>100㮓⃳㗪㚱庫⣂䘬↢

忂妲ἄ侭烉昛㝷暾, ⎘ᷕ㥖㮹䷥慓昊䤆䴻慓⬠ᷕ⽫儎ᷕ桐ᷕ⽫
E-mail: boringtw@gmail.com
DOI: 10.6318/FJS.202003_2(1).0002

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 ߨЖӰ‫ܒ‬ીՖ‫ܒ‬သϛॳ‫ת‬Ֆω‫ݖ‬᛾‫ݽސ‬ᕛࡾЕ
埨ḳẞ10ˤ㖍㛔⇯⺢嬘aspirin㭷㖍∹慷䁢75-150
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㮓⃳ ˤAspirin⎗傥䘬∗ἄ䓐⊭㊔烉⺞攟↢埨
㗪攻(䈡⇍㗗㭷⣑╅3㜗ẍᶲ䘬惺䱦梚㕁炻ㆾ㗗
⶚㚱↢埨⓷柴䘬か侭)ˣ儠偫忻⇢㽨(⤪儠偫忻
↢埨ˣ㳣≽⿏㼘䖵)ˤAspirin㚫㍸檀偫儠忻↢埨
䘬桐晒炻侴ᶼἧ䓐䘬∹慷グ檀炻桐晒グ檀 3, 6烊
攟㛇ἧ䓐aspirin㭷㖍∹慷<325㮓⃳䘬䕭Ṣ炻㭷
⸜䘤䓇♜慵偫儠忻↢埨䘬桐晒⣏䲬㗗0.4%炻㗗
ᶵἧ䓐aspirin㕷佌䘬2.5᾵ⶎ⎛3, 6, 12, 13ˤ㬌⢾炻
晾䃞⼰⮹䘤䓇炻Ữaspirin⎗傥⮶农♜慵䘬哩湣
䕡(3.5%)炻埨䭉㯜儓(4.5%烊儓僡⎗傥䘤䓇⛐
⒯ˣ冴ˣ┱♐䓂军㚫⼙枧␤⏠)炻ㆾ㗗㓗㯋䭉㓞
䷖(㯋╀䘤ἄ)ˤ⼰⣂∗ἄ䓐冯aspirin䘬∹慷䚠
斄炻∹慷庫檀⇯∗ἄ䓐庫⣂炻ỮỶ∹慷aspirin
ḇ⎗傥䘤䓇∗ἄ䓐ˤ
IJįĴġńŭŰűŪťŰŨųŦŭ
Clopidogrel㗗⻟侴⮰ᶨ䘬埨⮷㜧ↅ普㈹⇞
∹ˤClopidogrel䘬ἄ䓐䁢怠㑯⿏㈹⇞埨⮷㜧ᶲ
䘬▴␌⍿橼(purinergic receptor P2Y, G-protein
coupled 12, P2Y12)冯ADPᷳ䳸⎰炻⤪㬌ὧ㚫
㈹⇞䴻䓙ADP⨺ṳ䘬態噳䘥IIb/IIIa墯⎰橼䘬㳣
⊾ἄ䓐炻忚侴㈹⇞埨⮷㜧ↅ普炻㬌ἄ䓐㗗ᶵ⎗
微䘬ˤ⚈㬌炻↉㍍妠⇘clopidogrel䘬埨⮷㜧炻
⛐℞⢥␥㛇攻⛯㚫⍿⇘⼙枧ˤ晾䃞clopidogrel
ᶵ㚦⛐⽑䘤⿏儎ᷕ桐娎槿ᷕ冯⬱ㄘ∹ 忶㭼
庫炻clopidogrel㚦䴻⛐ℑᾳ冐⸲娎槿ᷕ╖䌐冯
℞Ṿ喍䈑 忶⮵㭼⿏䘬䞼䨞ˤ℞ᷕCAPRIE娎
槿13炻⊭㊔Ḯ19,185ỵ㚦㚱儎ᷕ桐ˣ⽫倴㠿⠆ˣ
ㆾ␐怲≽傰䕦䕭䘬䕭Ṣ炻晐㨇↮惵军aspirin
㭷㖍325㮓⃳ㆾclopidogrel㭷㖍75㮓⃳炻徥巐2
⸜炻䳸㝄栗䣢㔜橼⽫埨䭉䕦䕭ḳẞ䘤䓇䌯(⊭
㊔仢埨⿏儎ᷕ桐ˣ⽫倴㠿⠆⍲埨䭉ḳẞ忈ㆸ
䘬㬣ṉ)⛐aspirin䳬㗗5.83%炻侴clopidogrel䳬
⇯䁢5.32%炻䚠⮵桐晒(relative risk, RR)旵ỶḮ
8.7% (95%ᾉ岜⋨攻˳confidence interval, CI˴
= 0.3–16.5%烊P = 0.043)炻⛐枸旚埨䭉ḳẞᶲ庫
aspirin䦵ἛˤỮ㗗憅⮵㚱儎ᷕ桐䕭⎚䕭Ṣ䘬㫉
↮㜸炻clopidogrel䳬㭷⸜䘤䓇⽫埨䭉䕦䕭ḳẞ
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㗗7.15%炻侴aspirin䳬㗗7.71%炻ℑ䳬䃉栗叿ⶖ
䔘(RR旵Ỷ7.3%烊95%CI = -5.7%–18.7%烊P =
0.26)ˤ侴偫儠㕡朊㔜橼侴妨炻㚵䓐clopidogrel
䘬偫儠忻↢埨䘤䓇䌯栗叿Ỷ㕤aspirin (1.99%
㭼2.66%烊P < 0.05)ˤ⎎ᶨ枭PRoFESS娎槿14炻
ℙ㚱20,332ỵ朆⽫⚈⿏仢埨⿏儎ᷕ桐䕭Ṣ炻
晐㨇↮惵䴎Ḱclopidogrelㆾ⎰Ἕaspirin⍲
dipyridamole䘬㱣䗪炻䘤䎦⎰Ἕ㱣䗪䳬䘬儎ᷕ
桐⽑䘤䌯㗗9.0%炻侴clopidogrel䳬㗗8.8%炻ℑ
䳬㰺㚱ⶖ⇍炻Ữ㗗⎰Ἕ㱣䗪䳬㚱栗叿庫檀䘬栙
ℏ↢埨䘤䓇䌯(1.4%㭼1.0%烊桐晒㭼ῤ˳hazard
ratio, HR˴= 1.42烊95%CI = 1.11–1.83)ˤ⚈㬌炻
⮵aspirin㚱䤩⽴䕯ㆾ䓊䓇ᶵ列⼙枧䘬䕭Ṣ炻⎗
ẍ怠䓐clopidogrelˤ⮵㕤㚱㚜檀桐晒(⌛㚦㚱儎
ᷕ桐ˣ␐怲≽傰䕭嬲ˣ䕭⽝⿏ⅈ⽫䕭ㆾ䱾⯧䕭)
ㆾⅈ䉨≽傰ㇳ埻⼴䘬䕭Ṣ炻㚵䓐clopidogrel⎗
傥㭼aspirin㷃⮹庫⣂䘬⽫埨䭉ḳẞ13ˤ
IJįĵġńŪŭŰŴŵŢŻŰŭ
Cilostazol怠㑯⿏⛘㈹⇞䫔ᶱ✳䢟愠Ḵ愞
(phosphodiesterase)炻⮶农埨⮷㜧䑘䉨儢▴␌㟠
╖䢟愠(cAMP)䘬㽫⹎⡆≈炻忚ᶨ㬍⡆≈噳䘥
㽨愞A (protein kinase A)㳣⊾✳ン炻侴㈹⇞埨
⮷㜧䘬ↅ普ˤ噳䘥㽨愞Aḇ㚫㈹⇞倴䎫噳䘥庽
捰㽨愞(myosin light-chain kinase)䘬㳣⊾炻㈹⇞
⸛㹹倴㓞䷖炻忈ㆸ埨䭉㒜⻝䘬㓰㝄炻⚈㬌⎗䓐
㕤攻㫯⿏嶃埴䘬㱣䗪ˤ⛐枸旚儎ᷕ桐⽑䘤ḇ㚱
䚠斄娎槿炻㖍㛔䘬CSPS娎槿 15 炻䲵ℍ1,052ỵ
仢埨⿏儎ᷕ桐䘤䓇1–6ᾳ㚰䘬䕭Ṣ炻晐㨇↮惵
军cilostazol㱣䗪䳬(100㮓⃳㭷㖍2㫉)ㆾ⬱ㄘ∹
䳬ˤ⬱ㄘ∹䳬㭷⸜儎㠿⠆⽑䘤䌯㗗5.78%炻侴
cilostazol䳬⇯㗗3.37%炻䚠⮵桐晒ᶳ旵忼41.7%
(95%CI = 9.2%–62.5%烊P = 0.015)ˤẍ仢埨⿏儎
ᷕ桐Ṇ✳Ἦ婒炻⤪㝄䕭Ṣ㗗僼晁⿏㠿⠆(lacunar
stroke)炻cilostazol⎗ᶳ旵䚠⮵桐晒43.4%䘬
仢埨⿏儎ᷕ桐⽑䘤(95%CI = 3.0%–67%烊P =
0.0373)炻侴↢埨⿏ḳẞ㰺㚱栗叿⡆≈ˤ10⸜
⼴䘤堐䘬⎎ᶨᾳ㖍㛔娎槿CSPS-216炻ℙ㚱2,757
ỵ朆⽫⚈⿏儎ᷕ桐䕭Ṣ炻崭忶ℕㆸ㗗僼晁⿏㠿
 ߨЖӰ‫ܒ‬ીՖ‫ܒ‬သϛॳ‫ת‬Ֆω‫ݖ‬᛾‫ݽސ‬ᕛࡾЕ
⠆炻↮䁢cilostazol (100㮓⃳㭷㖍2㫉)ㆾ㗗aspirin
(㭷㖍81㮓⃳)炻䴻29ᾳ㚰䘬徥希炻cilostazol䳬
䘬㭷⸜儎ᷕ桐䘤䓇䌯㗗2.76%炻侴aspirin䳬⇍
㗗3.71% (HR = 0.74烊95%CI = 0.64–0.98烊P =
0.04)炻栗䣢cilostazol枸旚⽑䘤⿏儎ᷕ桐䘬㓰
㝄ᶵ廠䴎aspirin炻侴ᶼ㚱栗叿庫Ỷ䘬栙ℏ↢
埨⍲ℐ幓⿏↢埨䌯(㭷⸜0.77%㭼1.78%烊HR =
0.46烊95%CI = 0.30–0.71烊P = 0.0004)ˤ憅⮵
儎↢埨檀桐晒䕭Ṣ䘬㫉↮㜸 17炻僼晁⿏㠿⠆䕭
Ṣ䘬↢埨⿏儎ᷕ桐⸜䘤䓇䌯⛐cilostazolỶ㕤
aspirin (0.36%㭼1.20%烊HR = 0.35烊95%CI =
0.18–0.70烊P < 0.01)ˤ㬌⢾炻⛐埨⡻㍏⇞ᶵἛ
(㓞䷖⡻≥140 mm Hg)䘬䕭Ṣ炻cilostazol䳬䘬↢
埨⿏儎ᷕ桐⸜䘤䓇䌯栗叿Ỷ㕤aspirin䳬(0.45%
㭼1.44%烊P = 0.02)炻⚈㬌儎↢埨檀桐晒ᾳ㟰⎗
侫ㄖἧ䓐cilostazolˤ⛐ᶨ䭯䴙⎰↮㜸䘬⟙⏲ᷕ
18
炻cilostazol䚠庫㕤⬱ㄘ∹炻⎗栗叿㷃⮹42%
仢埨⿏儎ᷕ桐⽑䘤炻ᶼ↢埨⿏儎ᷕ桐䘬桐晒
䚠䔞烊cilostazol䚠庫㕤aspirin炻㚱㷃⮹15% 仢
埨⿏儎ᷕ桐⽑䘤䚠⮵桐晒䘬嵐⊊(RR = 0.85烊
95%CI = 0.65–1.10烊P = 0.22)炻⎎⎗栗叿㷃⮹↢
埨⿏儎ᷕ桐䘬桐晒忼61% (RR = 0.39烊95%CI =
0.25–0.61烊P < 0.0001)ˤỮCSPS-2娎槿喍䈑䘬
ᷕ㬊㭼䌯庫檀炻㚫⼙枧℞ᾉ⹎炻cilostazol䳬㚱
20%䕭Ṣ⚈∗ἄ䓐侴ᷕ㬊䓐喍炻aspirin䳬⇯㚱
12%⚈∗ἄ䓐侴ᷕ㬊䓐喍ˤCilostazol䳬㚱栗叿
庫⣂䘬∗ἄ䓐炻ἳ⤪柕䖃ˣ儡㾱ˣ⽫だ⍲柕㘰
䫱ˤ2019⸜㖍㛔㱣䗪㊯⺽ᷕcilostazol䘬⺢嬘䫱
䳂䁢Grade A 11炻侴⎘䀋TFDA⶚㕤2015⸜㟠Ⅾ
cilostazolἧ䓐⛐仢埨⿏儎ᷕ桐䘬㫉䳂枸旚炻⚈
㬌Ṇ㳚䘬仢埨⿏儎ᷕ桐㕷佌炻䈡⇍㗗䔞䕭Ṣ㚱
庫檀䘬儎↢埨桐晒㗪炻ἧ䓐cilostazolἮ枸旚⽑
䘤⿏儎ᷕ桐㗗⎗侫ㄖ䘬怠㑯ˤ
IJįĶġ‫ڏ‬тŵũŪŦůŰűźųŪťŪůŦŴ
IJįĶįIJġŕŪŤŭŰűŪťŪůŦ
Ticlopidine㗗埨⮷㜧P2Y12 ADP㍍⍿☐
䘬㊖㈿∹炻冯clopidogrelᷳἄ䓐㨇廱䚠⎴ˤ
忶 ⍣ 㚦 ⛐ 3 ᾳ 晐 㨇 娎 槿 ᷕ 忚 埴 19-21炻 忁 ṃ 娎
槿䘬䕭Ṣ㚱儎埨䭉䕦䕭䘬䕭⎚炻䳸㝄栗䣢
ticlopidine䚠庫㕤⬱ㄘ∹炻⎗ẍ旵Ỷ儎ᷕ桐䘬䘤
䓇䌯 19 炻Ữ䚠庫㕤aspirin䘬䳸㝄庫䁢↮㬏炻⛐
Antiplatelet Trialists’ Collaboration䘬䴙⎰↮㜸
ᷕ炻ticlopidine㭼aspirin晾傥旵Ỷ10%⽫埨䭉䕦
䕭䘬桐晒炻⌣䃉栗叿ⶖ䔘4烊Ticlopidine Aspirin
Stroke Study (TASS)䘬⟙⏲ᷕ㊯↢炻ticlopidine
䳬(㭷㖍500㮓⃳)㭼aspirin䳬(㭷㖍1,300㮓⃳)栗
叿旵Ỷ21%儎ᷕ桐䘬桐晒 20 烊⎎ᶨᾳ娎槿⇯栗
䣢冯aspirin䘬㓰㝄䚠䔞 21ˤ㬌⢾炻ticlopidine䚠
庫㕤℞Ṿ㈿埨⮷㜧喍䈑炻㚱庫⣂䘬ᶵ列ḳẞ桐
晒炻⤪柮䰺䎫㷃⮹䕯(⇅㛇䕯䉨烉䘤䅙ˣ⑥┱
䖃ˣ῎⿈デ䫱)ˣℵ䓇ᶵ列⿏屏埨ˣ埨⮷㜧㷃
⮹䕯ˣ儎↢埨ˣ㴰⊾忻↢埨ˣ湫䕠䫱♜慵∗ἄ
䓐 4 炻⚈㬌ἧ䓐ticlopidine䘬䕭Ṣ枰㕤⇵3ᾳ㚰
ℏ㭷2忙 ᶨ㫉埨㵚䚋㷔ˤ⮵㕤↢埨か侭(埨⍳
䕭ˣ⽖埨䭉傮⻙䕯ˣ㴰⊾䭉㼘䖵ˣ⯧嶗↢埨ˣ
⑛埨ˣ㘞䉨橼↢埨䫱)ˣ♜慵偅䕭ˣ䘥埨䎫㷃
⮹䕯ˣ㚵䓐ticlopidine⺽崟䘥埨䎫㷃⮹䕯冯忶㓷
か侭ㅱ䤩㬊㚵䓐ˤ伶⚳2014⸜䘬㱣䗪㊯⺽⺢嬘
22
炻䔞℞Ṿ㈿埨⮷㜧喍䈑ᶵ怑⎰ἧ䓐㗪炻⎗嫡
ヶἧ䓐ticlopidineˤ䚖⇵ticlopidine⛐⎘䀋TFDA
ḇṵᾅ㚱枸旚仢埨⿏儎ᷕ桐⽑䘤䘬怑ㅱ䕯(㭷㖍
200-500㮓⃳炻↮2-3㫉㚵䓐)炻Ữ⺢嬘䚋㷔䕭Ṣ
埨䎫㔠ˤ
IJįĶįijġŕŪŤŢŨųŦŭŰų
Ticagrelorḇ㗗ᶨᾳP2Y12㍍⍿☐䘬⎗微⿏
㊖㈿∹炻Ữᶵ⎴㕤clopidogrel䘬㗗℞䁢P2Y12
ADP㍍⍿☐䘬䚜㍍ἄ䓐喍䈑炻ᶵ暨天䴻忶ẋ
嫅㳣⊾炻⚈㬌ḇᶵ㚫⁷clopidogrelᶨ㧋⍿⇘
CYP2C19➢⚈⣂✳⿏䘬⼙枧ˤ㕤⿍⿏ⅈ⽫䕯
䕭Ṣ㇨忚埴䘬PLATO娎槿ᷕ炻ticagrelor䚠庫㕤
clopidogrel23炻晾䃞㚱庫Ỷ䘬⽫埨䭉ḳẞ炻Ữḇ
㚱庫⣂䘬慵⣏↢埨ḳẞ炻⛐PLATO娎槿墉憅⮵
㚱儎ᷕ桐䕭⎚䘬㫉↮㜸(䲬⌈6.2%⍿娎侭)ᷕ24炻
ticagrelor冯clopidogrel䳬䘬⽫埨䭉ḳẞ冯↢埨⿏
ḳẞ㰺㚱ⶖ䔘ˤ
7
 ߨЖӰ‫ܒ‬ીՖ‫ܒ‬သϛॳ‫ת‬Ֆω‫ݖ‬᛾‫ݽސ‬ᕛࡾЕ
IJįĶįĴġőųŢŴŶŨųŦŭ
Prasugrel䁢ᶨ䧖⇵槭喍䈑(prodrug)炻⛐
廱㎃䁢㳣⿏ẋ嫅䈑⼴炻德忶怠㑯⿏ᶼᶵ⎗
微䳸⎰军埨⮷㜧䘬P2Y12 ADP⍿橼炻䚠庫㕤
clopidogrel炻prasugrel⎗ẍ㚜⾓忇䘬㈹⇞埨⮷
㜧ↅ普ἄ䓐炻侴ᶼᶵ⍿CYP2C19➢⚈⣂⚈✳䘬
25, 26
⼙枧 ˤPrasugrel㚦⛐⿍⿏ⅈ⽫䕯㍍⍿⮶䭉ṳ
ℍㇳ埻䘬䕭Ṣ冯clopidogrel㭼庫27炻prasugrel≈
ᶲaspirin䚠庫㕤clopidogrel≈ᶲaspirin㚱庫Ỷ䘬
⽫冇仢埨ḳẞ炻Ữℑ侭䘬儎ᷕ桐䘤䓇䌯㰺㚱ⶖ
䔘炻侴ᶼprasugrel㚱庫⣂䘬慵⣏↢埨ḳẞ炻䈡
⇍㗗⸜漉> 75㬚ˣ橼慵< 60℔㕌ㆾ㚱儎ᷕ桐䕭⎚
䘬䕭Ṣˤ⛐2015⸜䘬䴙⎰↮㜸ḇ栗䣢prasugrel
䚠庫㕤clopidogrel䃉㱽ᶳ旵儎ᷕ桐䘤䓇䌯炻侴
28
ᶼ㚱庫檀䘬↢埨桐晒 ˤᶨᾳẍ朆⿍⿏㛇䘬朆
⽫⚈⿏儎ᷕ桐䕭Ṣ䁢㓞㟰⮵尉䘬晐㨇冐⸲娎
29
槿䘤䎦 炻ᷕỶ∹慷䘬prasugrel (㭷㖍3.75㮓⃳)
⎗ẍ栗叿䘬㷃⮹P2Y12䘬⍵ㅱ╖ỵ(prasugrel
reaction units, PRU)炻侴ᶼᶵ⍿CYP2C19䘬➢
⚈⣂✳⿏䘬⼙枧ˤ晐㨇冐⸲娎槿PRASTRO-I⮯
3,753ỵ朆⽫⚈⿏仢埨⿏儎ᷕ桐䘬䕭Ṣ㕤䘤䕭
⼴1-26忙攻晐㨇↮惵军prasugrel (㭷㖍3.75㮓⃳)
ㆾclopidogrel (㭷㖍75㮓⃳)炻娎槿㛇攻䁢96军
104忙炻䘤䎦⇅䳂娎槿䳪溆(仢埨⿏ḳẞ䘤䓇䌯)
᷎㰺㚱栗叿ⶖ䔘炻ℑ䳬䘬䘤䓇䌯⛯䁢4% (RR =
1.05烊95%CI = 0.76–1.44)炻ℑ䳬ᷳ攻䘬⎬枭↢
埨⿏ḳẞḇ㰺㚱栗叿ⶖ䔘炻prasugrel䃉㱽忼⇘
ᶵ≋㕤(non-inferiority) clopidogrel䘬`姕ˤ
IJįķġġӫ‫ٺځ‬ҢŢŴűŪųŪůЅѪՖω‫ݖ‬᛾‫ސ‬
IJįķįIJġġӫ‫ٺځ‬ҢŢŴűŪųŪůЅťŪűźųŪťŢŮŰŭŦ
Dipyridamole䘬ἄ䓐㨇廱㗗德忶㈹⇞
phosphodiesterase炻⇢㽨埨⮷㜧ᷳ儢㟠䑘䉨愞
(platelet adenylate cyclase)炻⮶农cAMP䘬㽫
⹎⡆≈炻忚ᶨ㬍㈹⇞埨⮷㜧农㳣⚈⫸(platelet
activating factor)ˣ先⍇(collagen)ˣ儢▴␌㟠
Ḵ䢟愠(ADP)䫱㇨⺽崟䘬埨⮷㜧ↅ普ἄ䓐ˤ㬌
8
⢾炻儢功(adenosine)℟㚱埨䭉㒜⻝䘬ἄ䓐炻㬌
Ṏ䁢dipyridamole䓊䓇埨䭉㒜⻝ἄ䓐䘬㨇⇞ᷳ
ᶨˤAspirin⎰Ἕdipyridamole㚦䴻⛐4ᾳ⣏✳䘬
晐㨇娎槿忚埴炻ESPS-1 30 ⮯2,500ỵ仢埨⿏儎
ᷕ桐䕭Ṣ晐㨇↮惵军⬱ㄘ∹䳬ㆾ⎰Ἕ喍䈑䳬
(⊭㊔325㮓⃳䘬aspirin⍲75㮓⃳䩳⌛慳㓦✳䘬
dipyridamole㭷㖍ᶱ㫉)炻䴻忶2⸜䘬徥希炻⎰Ἕ
喍䈑䳬䘬儎ᷕ桐ㆾ㬣ṉ䘬䘤䓇䌯㗗16%炻侴⬱
ㄘ∹䳬㗗25% (RR = 33%烊P < 0.001)ˤESPS-231
㗗ᶨ枭晐㨇ˣ暁䚚ᷳ⮵䄏䞼䨞炻ℙ6,602ᾳ㚦䴻
儎ᷕ桐ㆾ㗗TIA䘬䕭Ṣ炻↮䁢4ᾳ䳬⇍炻⊭㊔烉
aspirin 25㮓⃳≈ᶲ䶑慳✳dipyridamole 200㮓
⃳㭷㖍ℑ㫉ˣaspirin 25㮓⃳㭷㖍ℑ㫉ˣ䶑慳✳
dipyridamole 200㮓⃳㭷㖍ℑ㫉ˣ⬱ㄘ∹ˤ⎬䳬
⇍冯⬱ㄘ∹䚠庫炻ἧ䓐╖ᶨaspirin⎗㷃⮹18%
䘬儎ᷕ桐䚠⮵桐晒(P = 0.013)炻ἧ䓐╖ᶨ䶑慳✳
dipyridamole⎗㷃⮹16%䘬儎ᷕ桐䚠⮵桐晒(P =
0.039)炻⎰Ἕ喍䈑䳬⇯⎗㷃⮹37%䘬儎ᷕ桐䚠⮵
桐晒(P < 0.001)烊侴䚠庫㕤╖ᶨaspirin炻⎰Ἕ喍
䈑䳬⎗㷃⮹23%䘬儎ᷕ桐䚠⮵桐晒(P = 0.006)炻
侴ᶼ↢埨ḳẞ᷎㰺㚱栗叿⡆≈炻Ữ㗗柕䖃䕯
䉨䘬䡢㚫⡆≈ˤ䫔3ᾳ⣏✳娎槿㗗ESPRIT 32炻
ℙ4,500ỵ⛐6ᾳ㚰ᷳℏ㚦䴻㚱TIAㆾ仢埨⿏儎
ᷕ桐䘬䕭Ṣ炻晐㨇↮㳦军╖ᶨaspirin (30–325
㮓⃳)ㆾaspirin≈ᶲdipyridamole (200㮓⃳㭷㖍
ℑ㫉)炻奨⮇ℑ䳬㱣䗪⛐枸旚儎ᷕ桐⽑䘤ˣ⽫
倴㠿⠆ˣ埨䭉⿏㬣ṉㆾ㗗℞Ṿ慵⣏↢埨䘬㓰
㝄ˤ㬌娎槿aspirin䘬⸛⛯∹慷㗗㭷㖍75㮓⃳ˤ
䴻3.5⸜䘬徥希炻䷥橼埨䭉ḳẞ䘤䓇䌯⛐⎰Ἕ
喍䈑䳬㗗13%炻⛐╖ᶨaspirin䳬㗗16% (HR =
0.80烊95%CI = 0.66–0.98)ˤᶲ徘ᶱᾳ娎槿䘬
䴙⎰↮㜸䘤䎦 32炻aspirin≈dipyridamole䚠庫㕤
aspirin炻⎗䚠⮵㷃⮹18%䘬䵄⎰⿏埨䭉ḳẞˤ
䫔4ᾳ⣏✳䘬娎槿㗗PRoFESS14炻椾㫉⮵20,332
ỵ儎ᷕ桐䕭Ṣ忚埴䚜㍍㭼庫aspirin≈ᶲ䶑慳✳
dipyridamole墯㕡冯clopidogrel⮵㕤枸旚儎ᷕ桐
⽑䘤䘬喍㓰␴⬱ℐ⿏ˤ䞼䨞栗䣢晾䃞aspirin≈
ᶲ䶑慳✳dipyridamole墯㕡㭼clopidogrel㚱庫⣂
䘬↢埨ḳẞ(4.1%㭼3.6%烊HR = 1.15烊95%CI
 ߨЖӰ‫ܒ‬ીՖ‫ܒ‬သϛॳ‫ת‬Ֆω‫ݖ‬᛾‫ݽސ‬ᕛࡾЕ
= 1.00–1.32烊P = 0.057)⍲庫檀䘬栙ℏ↢埨㨇䌯
(1.4%㭼1.0%烊HR = 1.42烊95%CI = 1.11–1.83)炻
Ữ㔜橼ᷳ桐晒冯㓰䙲姽Ộ炻aspirin≈ᶲ䶑慳✳
dipyridamole墯㕡冯clopidogrel⛐儎ᷕ桐⽑䘤
ㆾ↢埨ḳẞᶲ㗗䚠Ụ䘬(11.7%㭼11.4%)ˤ䓙
㕤dipyridamoleᷳ埨䭉㒜⻝ἄ䓐炻⎗傥㚫忈ㆸ
Ỷ埨⡻ˣ䅙㼖䲭冯⽫㎷≈忇ˤDipyridamoleᷳ
∗ἄ䓐忂ⷠ㗗㙓㗪ᶼ庽⽖炻㚦奨⮇⇘䘬∗ἄ
䓐⊭㊔▼⎸(3%)ˣ儡㾱(2%)炻ẍ⍲ᶳ↿䕯䉨
⤪㘰䛑(5%)ˣ◩⽫(6%)ˣ柕䖃(10%)炻攟㛇ẍ
dipyridamole㱣䗪㗪炻忁ṃ∗ἄ䓐忂ⷠ㚫㴰⣙ˤ
IJįķįijġġӫ‫ٺځ‬ҢŢŴűŪųŪůЅŤŭŰűŪťŰŨųŦŭ
忶⍣⸦⸜㚱㔠ᾳ⣏✳冐⸲娎槿炻娎⚾㍊妶
攟㛇⎰Ἕἧ䓐clopidogrel⍲aspirin傥⏎㚱㓰旵
Ỷᷕ桐⽑䘤ˤMATCH娎槿㓞䲵7,599ỵ⛐3ᾳ㚰
ℏ㚦㚱仢埨⿏儎ᷕ桐ㆾTIA䘬䕭Ṣ33炻⸛⛯㓞㟰
㗪攻㗗ᷕ桐⼴26.5⣑炻晐㨇↮䳬军暁㈿埨⮷㜧
喍䈑(clopidogrel⍲aspirin)ㆾ╖ᶨclopidogrel炻
徥希18ᾳ㚰⼴炻䘤䎦暁㈿埨⮷㜧喍䈑䘬ἧ䓐䚠
庫㕤╖ᶨclopidogrel䃉㱽㷃⮹⽫埨䭉ḳẞㆾ儎
ᷕ桐䘬䘤䓇炻侴ᶼ暁㈿埨⮷㜧喍䈑䘬慵⣏↢埨
⿏ḳẞ栗叿⛘⡆≈炻农㬣⿏↢埨ḳẞ⡆≈Ḯ
1.3%炻ᶼ⍇䘤⿏儎↢埨䘤䓇䌯ḇ栗叿⡆≈(P =
0.029)炻⚈㬌MATCH娎槿栗䣢⛐忶Ḯ⿍⿏㛇䘬
仢埨⿏儎ᷕ桐䕭Ṣἧ䓐暁㈿埨⮷㜧喍䈑(aspirin
⍲clopidogrel)炻䚠庫㕤╖ᶨἧ䓐clopidogrel炻
᷎䃉㱽ⷞἮ㚜⤥䘬㓰䙲ˤCHARISMA娎槿䲵
ℍ15,603ỵ㚦㚱⽫埨䭉䕦䕭ㆾ⣂慵⌙晒⚈⫸䘬
34
檀桐晒䕭Ṣ 炻↮⇍䁢Ἕ䓐aspirin (㭷㖍75-162
㮓⃳)冯clopidogrel (㭷㖍75㮓⃳)ㆾ╖䌐ἧ䓐
aspirin炻䴻忶28ᾳ㚰䘬徥巐炻暁㈿埨⮷㜧喍䈑
䳬䘬䵄⎰⽫埨䭉ḳẞ䘤䓇䌯㗗6.8%炻侴╖㕡
aspirin䳬䘬䘤䓇䌯㗗7.3% (RR = 0.93烊95%CI =
0.83–1.05烊P = 0.22)炻㛒忼䴙妰栗叿烊侴憅⮵
㚦㚱ᷕ桐ᾳ㟰䘬㫉↮㜸炻暁㈿埨⮷㜧喍䈑䚠庫
㕤╖㕡aspirin炻ᶵ䃉㱽㷃⮹儎ᷕ桐䘬桐晒炻
⍵侴⡆≈↢埨䘬桐晒ˤ⛐⎎⢾ᶨᾳ⣏✳晐㨇娎
槿SPS3 35 炻㓞㟰⮵尉㗗⛐6ᾳ㚰ℏẍ儎䡩㋗忈
⼙嫱⮎䘬僼晁⿏㠿⠆䕭Ṣ炻ℙ㚱3,026ỵ䕭Ṣ塓
晐㨇↮惵⇘暁㈿埨⮷㜧喍䈑䳬(㭷㖍clopidogrel
75㮓⃳⍲aspirin 325㮓⃳)ㆾ╖㕡ἧ䓐aspirin (㭷
㖍325㮓⃳)䳬炻⸛⛯徥巐3.4⸜炻䳸㝄栗䣢暁㈿
埨⮷㜧喍䈑㱣䗪䃉㱽㷃⮹儎ᷕ桐ḳẞ䘤䓇䌯炻
晾䃞仢埨⿏儎ᷕ桐䘬䘤䓇䌯㚱ṃ⽖ᶳ旵炻Ữ㗗
↢埨⿏儎ᷕ桐䘬䘤䓇䌯ḇᶲ⋯ˤ暁㈿埨⮷㜧
喍䈑㱣䗪䳬䘬儎ᷕ桐⸜䘤䓇䌯䁢2.5%炻侴╖
㕡aspirin㱣䗪䳬⇯䁢2.7%炻䃉䴙妰ⶖ䔘炻侴ᶼ
暁㈿埨⮷㜧喍䈑㱣䗪㚱栗叿庫檀䘬㬣ṉ䌯(HR
= 1.52烊95%CI = 1.14–2.04烊P = 0.004)⍲慵⣏
↢埨ḳẞ(HR = 1.97烊95%CI = 1.41–2.71烊P <
0.001)炻䈡⇍㗗偫儠忻↢埨(HR = 2.14烊95%CI
= 1.36–3.36烊P < 0.001)ˤᶨ䭯䴙⎰↮㜸栗䣢36炻
⤪㝄仢埨⿏儎ᷕ桐䘬䕭Ṣ攟㛇(> 1⸜)ἧ䓐暁
㈿埨⮷㜧喍䈑(clopidogrel≈aspirinㆾaspirin≈
dipyridamole)䚠庫㕤╖㕡clopidogrel炻㚫㚱庫檀
䘬儎↢埨桐晒ˤ䷥䳸炻仢埨⿏儎ᷕ桐䕭Ṣㅱ性
⃵攟㛇⎰Ἕἧ䓐clopidogrel⍲aspirin䘬暁㈿埨⮷
㜧喍䈑炻⚈䁢䚠庫㕤ἧ䓐╖ᶨ㈿埨⮷㜧喍䈑炻
枸旚ᷕ桐㓰㝄᷎㰺㚱㭼庫⤥ˣᶼ㚫⡆≈↢埨桐
晒ˤ
IJįķįĴġӫ‫ٺځ‬ҢŢŴűŪųŪůЅŤŪŭŰŴŵŢŻŰŭ
晾䃞攟㛇ἧ䓐clopidogrel⎰Ἕaspirin䘬桐晒
⣂㕤䙲嗽炻cilostazol⎰Ἕaspirin⇯㚱庫䁢ᶵ⎴
䘬䳸㝄ˤ椾⃰㗗TOSS䞼䨞37炻䘤䎦⛐㚱㖶栗䕯
䉨⿏栙ℏ≽傰䊡䨬(ᷕ⣏儎≽傰⍲➢⸽≽傰)䘬
䕭Ṣ炻䴎Ḱaspirin (㭷㖍100㮓⃳)⎰Ἕcilostazol
(㭷㖍200㮓⃳)ἧ䓐6ᾳ㚰炻䚠庫ἧ䓐╖㕡aspirin
䳬炻埨䭉䊡䨬两临ら⊾䘬㭼ἳ栗叿庫⮹(7%㭼
29%烊P = 0.008)ˤᷳ⼴栆Ụ姕妰䘬TOSS-2䞼
䨞 38炻⇯㗗ᶨ䳬䴎Ḱcilostazol⎰Ἕaspirinˣ⎎
ᶨ䳬⇯䴎Ḱclopidogrel⎰Ἕaspirin炻䳸㝄栗䣢
ἧ䓐cilostazol晾䃞㚱庫Ỷ䘬䊡䨬ら⊾桐晒炻
Ữ᷎䃉䴙妰ⶖ䔘(9.5%㭼15.5%烊P = 0.092)炻
侴ᶼℑ䳬䘬埨䭉ḳẞḇ㰺㚱ⶖ䔘ˤᷳ⼴忚埴
䘬CATHARSIS娎槿 39炻⇯䘤䎦ἧ䓐aspirin⎰Ἕ
cilostazol侭炻䚠庫╖ᶨaspirin侭炻㚱㔠⫿ᶲ庫
9
 ߨЖӰ‫ܒ‬ીՖ‫ܒ‬သϛॳ‫ת‬Ֆω‫ݖ‬᛾‫ݽސ‬ᕛࡾЕ
檀Ữ䴙妰ᶵ栗叿䘬埨䭉䊡䨬ら⊾㭼ἳ(9.6%㭼
5.6%烊P = 0.53)炻ᶵ忶㫉䳂娎槿䳪溆䘬㇨㚱埨
䭉ḳẞㆾᷕ桐ḳẞ⇯㖶栗庫Ỷ(⊅䬿㭼˳odd
ratio, OR˴= 0.37烊P = 0.04)ˤ
㕤2019⸜䘤堐䘬CSPS.com䞼䨞ᷫ㗗ᶨ枭
40
㕤㖍㛔㓞㟰ᷳ⣂ᷕ⽫晐㨇⮵䄏冐⸲娎槿 炻㓞
䲵1,884ỵ⿍⿏ᷕ桐䘤䓇8-180⣑ℏᷳ䕭Ṣ炻㓞
㟰㧁㸾䁢檀桐晒䘬朆⽫⚈⿏ᷕ桐䕭Ṣ炻℞檀
桐晒⭂佑䁢烉(1) ≥ 50%ᷳ栙ℏ⢾⣏埨䭉䊡䨬烊
ㆾ (2) ℑ䧖ẍᶲ䘬埨䭉⌙晒⚈⫸(⊭㊔⸜䲨≥ 65
㬚ˣ檀埨⡻ˣ䱾⯧䕭ˣㄊ⿏僶䕭ˣ␐怲≽傰䕦
䕭ˣ㚱㛔㫉昌⢾ᷳ仢埨⿏ᷕ桐䕭⎚ˣ仢埨⿏⽫
冇䕭ˣㆾ㊩临㉥厠侭)ˤ⮯㓞㟰䕭Ṣ晐㨇↮䁢
ℑ䳬炻ᶨ䳬㈽ẍcilostazol䁢ᷣ⸡ᷳ暁慵㈿埨⮷
㜧喍(cilostazola㭷㖍200㮓⃳炻≈ᶲaspirin㭷㖍
81ㆾ100㮓⃳ㆾclopidogrel㭷㖍50ㆾ75㮓⃳)炻
⎎ᶨ䳬⇯䓐㧁㸾ᷳ╖㕡㈿埨⮷㜧喍(aspirinㆾ
clopidogrel)炻᷎攟㛇㚵䓐军⮹6ᾳ㚰ẍᶲˤ䳸
㝄⛐⸛⛯1.4⸜䘬徥希㗪攻ℏ炻ἧ䓐cilostazolᷳ
暁㈿埨⮷㜧喍䳬炻℞䘤䓇仢埨⿏ᷕ桐䘬桐晒㖶
栗旵ỶḮᶨ⋲(3%㭼7%烊HR = 0.49烊95%CI =
0.31–0.76)炻䵄⎰⿏埨䭉ḳẞḇ⎴㧋旵Ỷᶨ⋲
(4%㭼8%烊HR = 0.52烊95%CI = 0.35–0.77)炻
侴ᶼ℞♜慵↢埨ㆾ栙ℏ↢埨(1%㭼1%烊HR =
0.66烊P = 0.35)ᷳ㭼ἳ᷎㰺㚱ᶲ⋯炻ⓗ䌐⚈䁢
ᶵ怑⍵ㅱ侴 喍ᷳ㭼ἳṵ庫檀(66Ṣ㭼12Ṣ)ˤ
㬌䞼䨞ᷫ㗗䚖⇵㇨㚱ᷕ桐㕷佌ἧ䓐暁㈿埨⮷㜧
喍䔞ᷕ炻ⓗᶨ䘬ᶨᾳ攟㛇㚵䓐㚱㖶栗⤥嗽ᶼᶵ
㚫⡆≈↢埨䘬娎槿䳸㝄ˤ晾䃞㬌䞼䨞⛐㖍㛔
忚埴炻℞冐⸲㓰≃⢾㍐军℞ṾṢ䧖ㆾ姙ṵ㚱
䔹ㄖ炻Ữcilostazol⛐Ṇ㳚ᷕ桐䕭Ṣ㕷佌䘬㱣䗪
㓰䙲⶚㚱⣂䭯䞼䨞嫱⮎炻㓭䕭Ṣ䕭ね劍䫎⎰
CSPS.comᷳ㓞㟰㧁㸾炻⇯⎗侫ㄖ⛐Ṇ⿍⿏㛇⼴
㓡䓐ẍcilostazol䁢ᷣ⸡ᷳ暁㈿埨⮷㜧喍䈑ẍ枸
旚ℵᷕ桐ˤ
IJįĸġᢓϱသଢ଼૕๔‫ޑ‬฽Ͻ
栙ℏ儎≽傰䱍䉨䠔⊾㗗忈ㆸ儎ᷕ桐䘬ᷣ
⚈炻䕭Ṣ䘤䓇⽑䘤⿏儎ᷕ桐䘬桐晒ḇ朆ⷠ檀
10
41
炻䈡⇍㗗Ṇ㳚㕷佌炻栙ℏ儎≽傰䱍䉨䠔⊾䘬
䚃埴䌯㭼㫸伶㕷佌檀 42, 43ˤ2005⸜伶⚳WASID
暁䚚晐㨇娎槿䘬㓞㟰⮵尉㗗仢埨⿏儎ᷕ桐ㆾ
TIA炻ᶼ⎰Ἕ㚱栙ℏ儎≽傰䊡䨬忼50–99%䘬569
ỵ䕭Ṣ炻晐㨇↮惵军warfarin (INR㍏⇞⛐2–3)
ㆾaspirin (㭷㖍1,300㮓⃳)44ˤ䳸㝄䘤䎦仢埨⿏儎
ᷕ桐ˣ儎↢埨⍲℞Ṿ埨䭉䕦䕭忈ㆸ䘬㬣ṉ㰺㚱
ⶖ䔘炻Ữwarfarin䳬䘬㬣ṉ䌯⍲慵⣏↢埨䘤䓇䌯
㭼aspirin䳬栗叿⡆檀ˤ䓙㕤WASID娎槿䘬㫉↮
㜸䘤䎦45炻栙ℏ儎≽傰䊡䨬≥ 70%䘬䕭Ṣ䘤䓇ᷕ
桐⽑䘤䘬㭼䌯栗叿檀㕤< 70%䘬䕭Ṣ炻2008⸜
伶⚳⚳⭞堃䓇昊憅⮵栙ℏ儎≽傰䊡䨬70–99%ᶼ
⎰Ἕ仢埨⿏儎ᷕ桐䘬䕭Ṣ炻忚埴䘣抬䞼䨞 46炻
㭷ỵ䕭Ṣ⛯⎰Ἕἧ䓐clopidogrel(㭷㖍75㮓⃳)⍲
aspirin (㭷㖍81–325㮓⃳) 4–12忙炻᷎㍍⍿栙ℏ
儎≽傰㓗㝞㱣䗪炻䘤䎦6ᾳ㚰䘬ḳẞ䘤䓇䌯(⊭
㊔ảỽ儎ᷕ桐⍲30㖍ℏ㬣ṉ)䁢14.0%炻冯⇵徘
䘬WASID娎槿ᷕ栙ℏ儎≽傰䊡䨬70–99%䘬䘤䓇
䌯䚠Ụ炻栗䣢暁㈿⮷埨㜧喍䈑⎰Ἕ栙ℏ儎≽傰
㓗㝞㱣䗪㓰㝄⎗傥ᶵṆ㕤㈿埨㞻喍䈑ˤ
晐⼴伶⚳䘬SAMMPRIS娎槿 47炻䲵ℍ30㖍
ℏ㚱庽⽖仢埨⿏儎ᷕ桐ㆾTIAᶼ⎰Ἕ㚱栙ℏ儎
≽傰䊡䨬忼70–99%䘬451ỵ䕭Ṣ炻㭷ỵ䕭Ṣ⛯
ἧ䓐暁㈿埨⮷㜧喍䈑(clopidogrel㭷㖍75㮓⃳⍲
aspirin㭷㖍325㮓⃳)军90㖍炻ᶼ䧵㤝⛘㱣䗪⌙
晒⚈⫸炻䕭Ṣ晐㨇↮惵军㍍⍿栙ℏ儎≽傰㓗㝞
㱣䗪(㓗㝞䳬)ㆾᶵ㍍⍿㓗㝞㱣䗪(喍䈑䳬)ˤ䳸㝄
栗䣢㍍⍿㓗㝞䳬䘬⍇䘤ḳẞ(儎ᷕ桐ㆾ㬣ṉ)䘤
䓇䌯栗叿檀㕤ἧ䓐喍䈑䳬烊侴ᶼ⛐㬌娎槿2⸜
ẍᶲᷳ攟㛇徥希䳸㝄ḇ栗䣢 48炻╖䲼喍䈑䳬ℵ
ᷕ桐桐晒᷎ᶵ㚫㭼㓗㝞䳬檀炻嫱⮎喍䈑㛔幓䘬
㓰㝄⎗ẍ⺞临ᶳ⍣ˣ侴栙ℏ㓗㝞᷎㰺彎㱽⛐攟
㛇㍸ὃ㚜⣂䘬⤥嗽ˤ
㬌⢾炻⛐ᶳᶨ䪈ᷕ㚫㍸⇘䘬CHANCE娎
槿 炻 ℞ ᷕ ᶨ ᾳ 㫉 ↮ 㜸 栗 䣢 49炻 栙 ℏ 儎 ≽ 傰 䊡
䨬忼50–99%䘬䕭Ṣ炻ἧ䓐暁㈿埨⮷㜧喍䈑
(clopidogrel⍲aspirin)䘬䳬⇍䚠⮵㕤aspirin炻
㷃⮹Ḯ21%䘬儎ᷕ桐桐晒(HR = 0.79烊95%CI
= 0.47–1.32)炻晾䃞㰺㚱栗叿ⶖ䔘炻⌣栗䣢役
 ߨЖӰ‫ܒ‬ીՖ‫ܒ‬သϛॳ‫ת‬Ֆω‫ݖ‬᛾‫ݽސ‬ᕛࡾЕ
㛇儎仢埨⎰Ἕ⎴“㿴㳩栙ℏ儎≽傰䊡䨬䘬䕭
Ṣ炻䞕㛇ἧ䓐暁㈿埨⮷㜧喍䈑(clopidogrel⍲
aspirin)炻⎗傥㷃⮹儎ᷕ桐⽑䘤ˤᶲ㔯㍸忶ᷳ
37 38 39
TOSS ˣTOSS-2 ˣCATHARSIS 娎槿ᷕ炻䘤
䎦cilostazol傥䦵⽖㓡┬栙ℏ≽傰䊡䨬ら⊾ᷳ桐
40
晒ㆾ㷃⮹⽫埨䭉ḳẞ炻⛐CSPS.com娎槿ᷕ 炻
䛇㬋⚈栙ℏ≽傰> 50%䊡䨬侴㓞㟰侭⌈Ḯ30%ⶎ
⎛炻㬌㕷佌ἧ䓐cilostazolᷳ暁㈿埨⮷㜧喍Ṏ⎗
栗叿旵Ỷℵᷕ桐桐晒(4.0%㭼9.2%烊HR = 0.47烊
95%CI = 0.23–0.95)ˤ䵄妨ᷳ炻嫱㒂栗䣢憅⮵栙
ℏ儎≽傰䱍䉨䠔⊾䘬䕭Ṣ炻aspirin䚖⇵ṵ䁢⺢
嬘ᷳ椾怠㈿埨⮷㜧喍䈑炻᷎⎗侫ㄖ⛐⿍⿏㛇ㆾ
Ṇ⿍⿏㛇炻ẍ䞕㛇暁㈿埨⮷㜧喍䈑(aspirin≈
clopidogrel)Ἦ枸旚仢埨⿏儎ᷕ桐⽑䘤炻Ữẍᶵ
ἧ䓐崭忶90⣑䁢⍇⇯烊憅⮵㠿⠆檀桐晒ᶼ䫎⎰
CSPS.com㓞㟰㡅ẞᷳ䕭Ṣ炻⎗侫ㄖ攟㛇ἧ䓐ẍ
cilostazol䁢➢䢶ᷳ暁㈿埨⮷㜧喍䈑Ἦ枸旚儎ᷕ
桐ˤ
IJįĹġᓛഋଢ଼૕থᚔ
柠悐≽傰(柠≽傰ˣ傲㢶≽傰)∅暊⮶农䘬
ᷕ桐䲬⌈㇨㚱儎ᷕ桐䘬1-2%炻Ữ⌣㗗⸜庽✳ᷕ
50
桐䘬慵天ㆸ⚈炻⎗檀忼10-25% ˤ⛐埨䭉∅暊
嗽⼊ㆸ䘬埨㞻⼨怈䪗旣⠆炻塓㍐㷔㗗忈ㆸᷕ桐
䘬ᷣ⚈炻⚈㬌忶⼨㚱⬠侭㍸Έἧ䓐㈿ↅ埨∹⎗
傥㭼庫㚱㓰炻ỮṎ㚱ᶨ㳦婒㱽奢⼿╖䲼ἧ䓐㈿
埨⮷㜧喍䈑ḇ埴炻ᶼ㭼庫ᶵ㚫ら⊾埨䭉⡩ℏ䘬
↢埨(mural hematoma)ˤ忶⍣㚱ᶨ䭯㟡㒂40䭯奨
51
⮇⿏䞼䨞㇨ἄ䘬䴙⎰↮㜸䘤䎦 炻ἧ䓐㈿埨⮷
㜧喍䈑ㆾ㈿ↅ埨喍⮵㕤ℵᷕ桐(2.6%㭼1.8%烊
OR = 1.49)ㆾ㬣ṉ䌯(1%㭼0.8%烊OR = 1.27)⛯
㰺㚱栗叿ⶖ䔘ˤỮ䚜⇘2019⸜䘤堐䘬CADISS
52
娎槿 炻ㇵ椾㫉ἧ䓐晐㨇↮惵ᷳ冐⸲娎槿Ἦ㭼
庫㬌ℑ䧖䗪㱽炻⮵尉㗗250ỵ⛐7⣑ℏ䘤䓇柠悐
≽傰(柠≽傰ㆾ傲㢶≽傰)∅暊㇨⮶农仢埨⿏ᷕ
桐ㆾTIA䕭Ṣ(⸛⛯⸜漉䲬49㬚)炻126ỵ↮惵⇘
㈿ↅ埨∹(⿍⿏㛇ἧ䓐㧁㸾heparinㆾỶ↮⫸慷
heparin炻㍍叿攟㛇ἧ䓐warfarin᷎⮯INR㍏⇞
⛐2-3)炻⎎⢾124ỵ⇯↮惵⇘㈿埨⮷㜧喍(⎗ἧ
䓐aspirinˣclopidogrelˣdipyridamoleˣㆾ暁慵
㈿埨⮷㜧喍)炻㕤䕭䘤⼴⸛⛯3.26⣑㓞㟰炻ἧ
䓐喍䈑军⮹3ᾳ㚰ˣ᷎徥希1⸜炻䳸㝄䘤䎦⛐⎴
“埨䭉䭬⚵ℏ㚱6㫉ℵᷕ桐ḳẞ(1⸜2.4%)炻
℞ᷕ㈿埨⮷㜧喍䳬㚱4ỵˣ㈿ↅ埨喍䳬㚱2ỵ炻
᷎㰺㚱忼⇘䴙妰ᶲⶖ䔘(㈿ↅ埨喍䚠庫㈿埨⮷
㜧喍䳬ᷳHR = 0.56烊95%CI = 0.10–3.21烊P =
0.51)炻ᶼ⮵㕤徥希䘬埨䭉㓅⼙ᶲ㗗⏎㚱埨䭉ℵ
忂(recanalization)ḇ㰺㚱ⶖ䔘(OR = 1.04烊95%CI
= 0.69–3.37烊P = 0.09)ˤ㬌䞼䨞栗䣢炻⮵㕤柠悐
≽傰∅暊⮶农䘬仢埨⿏ᷕ桐炻ἧ䓐㈿ↅ埨喍ㆾ
㈿埨⮷㜧喍᷎ᶵ㚫⮵枸⼴㚱㖶栗䘬ⶖ䔘炻⚈㬌
ℑ䧖喍䈑䘮⎗侫ㄖἧ䓐ˤ
IJįĺġкଢ଼૕๔‫ޑ‬฽Ͻය༵
姙⣂嫱㒂㊯↢炻ᷣ≽傰⺻ㆾ傠ᷣ≽傰䘬䱍
䉨䠔⊾㔹⟲冯仢埨⿏儎ᷕ桐䘬桐晒ᶲ⋯㚱斄Ὢ
53, 54
炻䈡⇍㗗儎ᷕ桐䘬桐晒冯ᷣ≽傰䘬䱍䉨䠔
⊾㔹⟲♜慵⹎㚱䚠斄 55炻䔞䱍䉨䠔⊾㔹⟲䘬⍂
⹎> 4 mm㗪炻儎ᷕ桐䘬桐晒㗗< 1 mm侭䘬13.8
᾵ˤ⎎⢾炻昌Ḯ⍂⹎炻℞Ṿ䈡⽝ḇ⎗ẋ堐♜慵
ᷣ≽傰䘬䱍䉨䠔⊾㔹⟲炻ἳ⤪㚱埨㞻ˣ㼘䖵ˣ
ㆾ⣏䘬傪偒㟠(lipid core)炻悥㚱庫檀䘬儎ᷕ桐
桐晒 56, 57炻⼰栗䃞䘬炻♜慵䘬ᷣ≽傰⺻䱍䉨䠔
⊾㔹⟲㗗儎ᷕ桐䘬⌙晒⚈⫸ˤ军㕤㈿埨㞻喍䈑
⛐ᷣ≽傰⺻䱍䉨䠔⊾㔹⟲䘬㱣䗪䞼䨞䚠䔞㚱旸
ᶼ䳸㝄↮㬏 58-60炻侴ἧ䓐statin䘬か侭炻䚠庫㕤
㰺㚱ἧ䓐侭炻⇯⎗傥㚫㚱庫Ỷ䘬㬣ṉ䌯ㆾ㷃⮹
儎ᷕ桐⍲℞Ṿ㞻⠆ḳẞ 60, 61 ˤ⛐ARCH冐⸲娎
槿ᷕ 62 炻㓞㟰⮵尉㗗㚱仢埨⿏儎ᷕ桐ˣTIAㆾ
␐怲⿏㞻⠆ḳẞ炻ᶼ⎰Ἕ㚱傠ᷣ≽傰䱍䉨㔹⟲
⍂⹎> 4 mm䘬䕭Ṣ炻晐㨇↮惵军暁㈿埨⮷㜧
喍䈑(aspirin㭷㖍75–150㮓⃳≈clopidogrel㭷㖍
75㮓⃳炸ㆾ⎋㚵㈿ↅ埨∹warfarin (䚖㧁PT INR
2-3)炻Ữ⚈㓞㟰⚘暋炻䲵ℍ349ỵ䕭Ṣ炻⸛⛯
徥巐3.4⸜炻暁㈿埨⮷㜧喍䈑䳬㭷⸜䘬䵄⎰⿏埨
䭉ḳẞ䘤䓇䌯㗗2.2%炻侴㈿ↅ埨∹䳬㗗3.5%炻
暁㈿埨⮷㜧喍䈑䚠⮵㷃⮹24%桐晒(HR = 0.76烊
95%CI = 0.36–1.61烊P = 0.5)炻晾䃞㰺㚱䴙妰ⶖ
11
 ߨЖӰ‫ܒ‬ીՖ‫ܒ‬သϛॳ‫ת‬Ֆω‫ݖ‬᛾‫ݽސ‬ᕛࡾЕ
䔘炻Ữ䘤䎦暁㈿埨⮷㜧喍䈑䳬栗叿⛘㷃⮹埨䭉
⿏㬣ṉ䘤䓇䌯(P = 0.013)ˤ⚈㬌炻仢埨⿏儎ᷕ桐
ㆾTIA⎰Ἕ㚱ᷣ≽傰⺻≽傰䱍䉨䠔⊾䘬䕭Ṣ炻
ṵ⺢嬘ẍ╖㕡㈿埨⮷㜧喍䈑䁢椾怠㱣䗪Ἦ枸旚
⽑䘤⿏儎ᷕ桐ˤ军㕤㈿ↅ埨∹ㆾ暁㈿埨⮷㜧喍
䈑⇯暨天忚ᶨ㬍䘬䞼䨞嫱㒂ˤ
IJįIJıġ‫ྛپ‬Ϛ݂Ϟ੃༬࠮ϛॳ
Ἦ㸸ᶵ㖶ᷳ㞻⠆✳ᷕ桐(Embolic stroke of
undetermined source, ESUS)㕤2014⸜䓙Hart䫱
Ṣ ㍸ ↢ 63炻 ᷫ ᶨ グ 䘤 塓 慵 夾 ᷳ 仢 埨 ⿏ ᷕ 桐 Ṇ
✳ˤ䚠㭼㕤ẍ⼨ᷳ晙㸸⿏儎ᷕ桐(cryptogenic
stroke)炻℞姢㕟ᶲ㚱㚜㖶䡢䘬⭂佑炻䴻忶娛䳘
䘬儎悐⼙⁷⬠⍲⽫冇㩊㞍ᷳ⼴炻䡢娵ᶵ㗗⮷埨
䭉⟝⠆ˣᶵ㗗崭忶50%ẍᶲ⣏≽傰䱍䉨䠔⊾䊡
䨬ˣᶵ㗗ⷠ夳䘬⽫⚈⿏㞻⠆ˣḇ㰺㚱℞Ṿ䈡⭂
⮹夳䘬䕭⚈炻⇯⎗䧙ᷳ䁢ESUSˤ⛐㱣䗪Ⰼ朊
ᶲ炻䓙㕤䕭䎮⬠䞼䨞䘤䎦ESUSᷳ埨㞻ㆸ↮冯
⽫⚈⿏㞻⠆栆Ụ64炻ᶼⰔ㕤ESUS䘬⎗傥⍇⚈⊭
㊔Ḯ昋䘤⿏⽫㇧栓≽ˣ⌝⚻⫼㛒攱⎰ˣ庽⽖桐
晒ᷳ⽫埨䭉䕦䕭ˣㆾ䗴䕯䚠斄ᷳᷕ桐䫱炻䘮㘿
䣢ESUS⎗傥⤪⎴⽫⚈⿏㞻⠆ᶨ㧋炻⮵㕤㈿ↅ埨
∹㱣䗪⍵ㅱ庫⤥炻㓭埵䓇↢憅⮵ESUS䕭Ṣˣ
㭼庫䚜㍍⎋㚵㈿ↅ埨∹(direct oral anticoagulant,
DOAC)冯㈿埨⮷㜧喍䈑㱣䗪䘬⣏✳冐⸲娎槿ˤ
䚖⇵⶚䘤堐䘬㚱ℑ枭炻Ữ䳸㝄ἧ䓐DOAC悥
㛒傥㭼㈿埨⮷㜧喍䈑䁢Ἓˤ℞ᶨ䁢2018⸜䘤
堐䘬NAVIGATE ESUS冐⸲娎槿 65炻㭼庫ἧ䓐
rivaroxaban (㭷㖍15㮓⃳)冯aspirin (㭷㖍100㮓
⃳)㕤7,372ỵ50㬚ẍᶲESUS䕭Ṣᷳ䗪㓰炻⛐徥
希11ᾳ㚰䔞ᷕ炻㭷⸜儎ᷕ桐ㆾℐ幓⿏㞻⠆⽑䘤
䘬㭼䌯↮⇍䁢5.1%冯4.8% (HR = 1.07烊95%CI
= 0.87–1.33烊P = 0.52)炻ᶼἧ䓐rivaroxaban侭♜
慵⿏↢埨㖶栗ᶲ⋯(1.8%㭼0.7%烊HR = 2.72烊
95%CI = 1.68–4.39烊P < 0.001)ˤ⎎ᶨᾳ冐⸲娎
槿⇯㗗2019⸜䘤堐䘬RE-SPECT ESUS66炻㭼庫
ἧ䓐dabigatran (㭷㖍150ㆾ110㮓⃳)冯aspirin (㭷
㖍100㮓⃳)㕤5,390ỵESUS䕭Ṣᷳ䗪㓰炻徥希
19ᾳ㚰ᶳ炻㭷⸜儎ᷕ桐⽑䘤㭼䌯䁢4.0%冯4.7%
12
(HR = 0.85烊95%CI = 0.69–1.03烊P = 0.10)炻侴慵
⣏↢埨㭼䌯⇯䁢1.7%冯1.4% (HR = 1.19烊95%CI
= 0.85–1.66)ˤ䵄⎰Ἦ婒炻忁ℑ娎槿悥䃉㱽㓗
㊩㕤ESUS䕭Ṣ幓ᶲἧ䓐DOAC㚫⃒㕤aspirin炻
ᶼ怬⎗傥㚱⡆≈↢埨䘬桐晒ˤ⚈㬌炻⛐㚱㚜
⣂冐⸲娎槿䳸㝄(ἳ⤪忚埴ᷕ䘬ATTICUS冯
ARCADIA娎槿炻䘮䁢㭼庫apixaban冯aspirin炻
Ữ䘮枰㚱庫♜㟤冯⽫冇⌙晒⚈⫸䚠斄䘬㓞㟰㡅
ẞ)↢Ἦᷳ⇵炻憅⮵冐⸲ᶲ㆟䔹ESUS䘬䕭Ṣ炻
䚖⇵ṵᶵ⺢嬘ἧ䓐㈿ↅ埨∹Ἦ㱣䗪炻侴⎗⃰ἧ
䓐㈿埨⮷㜧喍䈑Ἦ枸旚ᷕ桐ˤ
IJįIJIJġο݈‫ת‬Ֆω‫ݖ‬᛾‫ޟސ‬ᒵᐅ
ẍᶲ䘬嫱㒂栗䣢aspirinˣticlopidineˣ
cilostazolˣ⍲⎰Ἕἧ䓐aspirin冯dipyridamole⎗
㚱㓰䘬枸旚儎ᷕ桐䘬⽑䘤炻晾䃞㰺㚱ảỽ䘬
儎ᷕ桐晐㨇暁䚚娎槿⮯clopidogrel冯⬱ㄘ∹⛐
⽑䘤⿏儎ᷕ桐䘬枸旚ᶲ 㭼庫炻䃉㱽㶭㤂䘬
㊯↢⬫㗗⏎㭼℞Ṿ䘬喍䈑Ἦ⼿㚱㓰炻Ữ㗗㟡
㒂CAPRIE 67⍲PRoFESS 14忁ℑᾳ娎槿䘬䓇⬀㚚
䶂Ἦ䚳炻clopidogrel⛐儎ᷕ桐⽑䘤䘬枸旚㓰㝄
⎗傥冯aspirinㆾ⎰Ἕἧ䓐aspirin⍲dipyridamole
ᶨ㧋㚱㓰炻䈡⇍㗗䔞䕭Ṣ㚵䓐aspirin㗪䘤䓇忶
㓷ㆾ偫儠忻∗ἄ䓐㗪炻clopidogrel㗗ᶨᾳ怑䔞
䘬怠㑯ˤỮ天㲐シ㚦㚱䞼䨞栗䣢ἧ䓐㯓暊⫸
⸓㴎㈹⇞∹(PPI)炻⤪omeprazole炻⎗傥㚫旵Ỷ
clopidogrel䘬㈹⇞埨⮷㜧㓰㝄68, 69炻晾䃞㰺㚱嫱
㒂栗䣢㚫⚈㬌⡆≈埨䭉ḳẞ䘤䓇䌯 70炻Ữṵ⺢
嬘ἧ䓐clopidogrel䘬䕭Ṣ⤪暨ἧ䓐⇞愠∹㗪炻
ㅱ⃒⃰侫ㄖἧ䓐H2⍿橼旣㈿∹炻⃀⎗傥性⃵ἧ
䓐omeprazole炻⚈䁢omeprazole㚫㈹⇞CYP2C19
P-450 cytochrome䘬ἄ䓐ˤ䚖⇵䘬嫱㒂栗䣢⎰
Ἕἧ䓐aspirin⍲dipyridamole炻䚠庫㕤╖㕡ἧ䓐
aspirin炻⛐枸旚儎ᷕ桐⽑䘤31 ⍲䵄⎰⿏ḳẞ(儎
ᷕ桐ˣ⽫倴㠿⠆ˣ㬣ṉ⍲慵⣏↢埨)32 ᶲ⎗傥㚜
䁢㚱㓰ˤ⤪㝄ἧ䓐dipyridamole䘬䕭Ṣ䘤䓇柕䖃
㗪炻⎗ẍ怠㑯ἧ䓐╖㕡aspirinㆾ㗗clopidogrelˤ
㕤庽⹎≇傥⍿㎵ᷳ役㛇仢埨⿏儎ᷕ桐ㆾTIAᷳ
䕭Ṣᶼ⎰Ἕ栙ℏ㿴㳩儎≽傰䊡䨬忼70–99%䘬ᾳ
 ߨЖӰ‫ܒ‬ીՖ‫ܒ‬သϛॳ‫ת‬Ֆω‫ݖ‬᛾‫ݽސ‬ᕛࡾЕ

㟰炻⎗ẍ䞕㛇⎰Ἕἧ䓐aspirin⍲clopidogrel军3 ⮷㜧喍䈑㱣䗪䘬㗪攻ˤ晾䃞㚱ẍᶲℑᾳ奨⮇⿏
ᾳ㚰ˤ䚖⇵㰺㚱嫱㒂㓗㊩攟㛇⎰Ἕἧ䓐䘬㓰䙲 䞼䨞䘬䳸㝄㓗㊩炻䚖⇵᷎㰺㚱晐㨇冐⸲娎槿嫱
⍲⬱ℐ⿏炻Ữ儎ᷕ桐䘬䕭Ṣ⤪⎴㗪⎰Ἕ⿍⿏ⅈ ⮎炻䔞䕭Ṣἧ䓐aspirinね㱩ᶳṵ䘤䓇仢埨⿏儎
⽫䕯ㆾ㍍⍿ⅈ䉨≽傰埨䭉㓗㝞䘬ね㱩ᶳ炻⎗ẍ ᷕ桐炻廱㎃ㆾ≈ᶲ䫔Ḵ栆㈿埨⮷㜧喍䈑㗗⏎㚱
侫ㄖ攟㛇⎰Ἕἧ䓐aspirin⍲clopidogrel 71, 72ˤ军 㓰ˤ⚈㬌炻㚵䓐╖㕡㈿埨⮷㜧喍䈑䘬ね㱩ᶳṵ
㕤ticlopidine⛐枸旚儎ᷕ桐⽑䘤ᶲ⎗傥㭼aspirin 䘤䓇儎ᷕ桐炻ㅱ⎴㗪侫慷䕭Ṣ䘬⌙晒⚈⫸㗗⏎
Ἦ⼿㚱㓰20炻Ữ㗗⬱ℐ⿏䘬䔹ㄖ(⯌℞㗗柮䰺䎫 ⶚䴻㍏⇞⼿⭄炻䴻㔜橼姽Ộ⤥嗽⍲⢆嗽⼴炻⎗
㷃⮹䕯䘬∗ἄ䓐)旸⇞Ḯ⬫䘬冐⸲ㅱ䓐ˤ㬌⢾炻 ẍ侫ㄖ廱㎃㈿埨⮷㜧喍䈑ㆾ䞕㛇≈ᶲ䫔Ḵ栆㈿
㕤Ṇ㳚㕷佌炻cilostazol⎗ẍἄ䁢枸旚儎ᷕ桐⽑ 埨⮷㜧喍䈑ˤ
䘤䘬喍䈑烊⮵㕤䃉㱽ἧ䓐aspirinㆾẍaspirin㱣䗪 军㕤⮎槿⭌ᷕ㈿埨⮷㜧喍䈑䘬㈿喍⿏㩊
ᶳṵ䘤䓇䵄⎰埨䭉ḳẞ䘬䕭Ṣ炻㕤㌺昌⽫堘䪕 槿炻㚱⟙⏲㊯↢ⅈ䉨≽傰䕦䕭䘬䕭Ṣ⤪㝄⮵
䕭⎚⼴炻⎗ἧ䓐cilostazol (100㮓⃳㭷㖍ℑ㫉)㕤 aspirinㆾ㗗clopidogrel䘬㈿埨⮷㜧⍵ㅱ庫ⶖ炻
㫉䳂儎ᷕ桐枸旚炻䈡⇍㗗僼晁✳儎㠿⠆ㆾ檀↢ ⎗傥㚫㚱庫⣂䘬仢埨⿏埨䭉ḳẞㆾ㗗㬣ṉḳẞ
75
埨⿏桐晒䘬䕭Ṣ烊⮵㕤檀桐晒㕷佌炻ἳ⤪㖶䡢 ˤ晾䃞冐⸲ᶲ⎗ẍ⮯忁ṃ℟㚱㈿喍⿏䘬䕭Ṣ
䘬栙ℏ⢾⣏埨䭉䊡䨬炻ㆾ㚱⣂枭埨䭉⌙晒⚈⫸ 廱㎃ㆸ℞Ṿ㚧ẋ喍䈑ㆾℵ≈ᶲ䫔Ḵ䧖㈿埨⮷㜧
ᷳ䕭Ṣ炻Ṏ⎗侫ㄖἧ䓐ẍcilostazol䁢ᷣˣ≈ᶲ 喍䈑炻Ữ忁㧋䘬 㱽℞⮎㚱桐晒炻⚈䁢䚖⇵᷎
aspirinㆾclopidogrelᷳ暁慵㈿埨⮷㜧喍䈑ˤ 㰺㚱䞼䨞嫱㒂㓗㊩忁㧋䘬ἄ㱽ˤ㚱ᶨᾳ娎槿⇑
䓐⮎槿⭌㩊㞍Ἦ⇌⭂㍍⍿ⅈ䉨≽傰㓗㝞㱣䗪
IJįIJijġġ݈Ң‫ת‬Ֆω‫ݖ‬᛾‫ޟސ‬௑‫ݷ‬ή 䘬䕭Ṣ㗗⏎⮵㚵䓐ᷕ䘬㈿埨⮷㜧喍䈑䁢ᶵ⍵ㅱ
ϫีҡသϛॳ 侭炻᷎㒂㬌Ἦ婧㔜喍䈑炻䘤䎦㚦䴻婧㔜喍䈑䘬
䔞ᶨᾳ⶚䴻⛐㚵䓐㈿埨⮷㜧喍䈑䘬䕭Ṣ 䕭Ṣ晾䃞㚱庫檀䘬⽫埨䭉ḳẞ䘤䓇䌯炻Ữ㰺㚱
ṵ䘤䓇儎ᷕ桐㗪炻廱㎃㈿埨⮷㜧喍䈑㗗⏎傥㷃 栗叿䘬䴙妰ⶖ䔘 76 ˤ侴⎎⢾ᶨᾳ䞼䨞 77 炻⊭⏓
⮹㛒Ἦ儎ᷕ桐⽑䘤䘬㨇䌯㗗ᶨᾳⷠ夳䘬冐⸲⓷ Ḯ仢埨⿏儎ᷕ桐ㆾTIA䘬䕭Ṣ炻⇑䓐埨⮷㜧ↅ
73
柴ˤ㚱ᶨ䭯䞼䨞⇑䓐⎘䀋‍ᾅ屯㕁⹓ 炻↮㜸 普㷔娎Ἦ㰢⭂䕭Ṣ㗗⏎⮵㈿埨⮷㜧喍䈑㚱⍵ㅱ
ἧ䓐aspirinね㱩ᶳṵ䘤䓇儎ᷕ桐䘬䕭Ṣ炻廱㎃ ⿏炻ḇ䘤䎦㚦㍍⍿㈿埨⮷㜧喍䈑婧㔜䘬ᾳ㟰㚱
䁢clopidogrelㆾ䵕㊩ἧ䓐aspirin⮵㛒Ἦ儎ᷕ桐䘤 庫檀䘬㬣ṉ䌯ˣ↢埨⍲仢埨⿏ḳẞ(HR = 2.24烊
䓇䌯䘬ⶖ䔘炻䳸㝄栗䣢廱㎃䁢clopidogrel䘬䕭 95%CI = 1.12–4.47烊P = 0.02)ˤ昌Ḯ喍䈑㛔幓炻
Ṣ㚱庫Ỷ䘬䵄⎰ḳẞ䘤䓇䌯(HR = 0.54烊95%CI 䕭Ṣ㚵喍䘬思⽆⿏ˣ⎰Ἕ䕯ˣㆾ⌙晒⚈⫸ḇ⎗
= 0.43–0.68烊P < 0.001)⍲庫Ỷ䘬儎ᷕ桐⽑䘤䌯 傥⼙枧㈿埨⮷㜧喍䈑䘬㈿喍⿏㩊槿䳸㝄 75炻侴
(HR = 0.54烊95%CI = 0.42–0.69烊P < 0.001)ˤ ᶼ㈿喍⿏㩊槿䘬㔠ῤ⯂㛒㧁㸾⊾炻⚈㬌ẍ䚖⇵
74
⎎⢾炻⛐ᶨᾳ杻⚳䘬䘣抬䞼䨞ᷕ 炻⮵㕤⶚㚵 䘬嫱㒂侴妨炻ἳ埴⿏㩊㷔埨⮷㜧ↅ普≇傥᷎ᶵ
䓐aspirinṵ䘤䓇仢埨⿏儎ᷕ桐䘬䕭Ṣ炻⤪㚧㎃ 傥䓐Ἦ䔞ἄ㗗⏎婧㔜㈿埨⮷㜧喍䈑㱣䗪䘬⍫
军℞Ṿ㈿埨⮷㜧喍䈑䘬╖㕡㱣䗪(clopidogrelỼ 侫ˤ
80.5%)ㆾ≈ᶲ⎎ᶨ㈿埨⮷㜧喍䈑䘬暁㈿埨⮷㜧
喍䈑㱣䗪(aspirinἝ䓐clopidogrelỼ87.1%)炻1⸜ IJįIJĴġġ݈Ң‫ת‬Ֆω‫ݖ‬᛾‫ޟސ‬௑‫ݷ‬ή
ℏ㚫㚱庫Ỷ䘬⽫埨䭉⍲㬣ṉḳẞ炻ᶼ暁㈿埨⮷ ีҡသюՖ
㜧喍䈑㱣䗪䘬䕭Ṣ㚱庫Ỷ䘬儎ᷕ桐䘤䓇䌯(HR ⎎ᶨ䧖冐⸲ᶲ㢀ㇳ䘬ね㱩⇯㗗炻䔞ᶨᾳ
= 0.45烊95%CI = 0.25–0.83)ˤ娚䞼䨞㰺㚱䴙妰 ⶚䴻⛐㚵䓐㈿埨⮷㜧喍䈑䘬䕭Ṣ䘤䓇Ḯ儎↢
↢埨⿏ḳẞ䘤䓇䌯炻ḇᶵ㶭㤂㊩临ἧ䓐暁㈿埨 埨ˣ䈡⇍㗗冒䘤⿏儎↢埨㗪炻㈿埨⮷㜧喍䈑

13
 ߨЖӰ‫ܒ‬ીՖ‫ܒ‬သϛॳ‫ת‬Ֆω‫ݖ‬᛾‫ݽސ‬ᕛࡾЕ
㗗⏎娚两临≈⚆⍣炻ẍ⍲娚怠㑯⒒䧖䓐喍ˤ椾
⃰炻PICASSO娎槿娎⚾㍊妶⒒䧖㈿埨⮷㜧喍
78
䈑庫䁢⬱ℐ 炻㬌娎槿㓞䲵Ḯ1,534ỵ役㛇ℏ䘤
䓇仢埨⿏儎ᷕ桐ˣỮ⍰㚱儎↢埨檀⹎桐晒ᷳ䕭
Ṣ炻檀桐晒⭂佑䁢㚦㚱儎↢埨ᷳ䕭⎚ㆾ⼙⁷嫱
㒂炻ㆾ侭儎悐㟠䡩ℙ㋗䘤䎦军⮹㚱ℑᾳẍᶲ䘬
⽖↢埨溆(cerebral microbleeds)炻℞ᷕᶨ䳬ἧ䓐
cilostazol (㭷㖍200㮓⃳)炻⎎ᶨ䳬ἧ䓐aspirin (㭷
㖍100㮓⃳)ˤ䳸㝄䘤䎦ἧ䓐cilostazol䳬㭷⸜䘤
䓇儎↢埨䘬㨇㚫䚠庫aspirin䦵ỶˣỮ㰺㚱忼⇘
䴙妰栗叿(0.61%㭼1.20%烊HR = 0.51烊95%CI
= 0.20–1.27)炻侴䵄⎰⿏埨䭉ḳẞ⇯㗗ᶵ≋㕤
aspirin (4.27%㭼5.33%烊HR = 0.80烊95%CI =
0.57-1.11烊P = 0.0077)ˤ㓭憅⮵㚦㚱儎↢埨ᷳ䕭
Ṣ炻ṵ⎗侫ㄖἧ䓐㈿埨⮷㜧喍Ἦ枸旚炻ⓗ枰㲐
シ㬌娎槿ᷕ㓞㟰䕭Ṣ䛇㬋䘤䓇忶儎↢埨䘬Ỽ
䲬40%ˤ
⎎ᶨ枭㕤2019⸜䘤堐䘬RESTART䞼䨞䁢
ᶨ晐㨇ˣ朆暁䚚(Ữ㚱䌐䩳姽Ộ侭⇌㕟枸⼴)冐
79
⸲娎槿 炻㓞䲵Ḯ537ỵ⛐㚵䓐㈿埨⮷㜧喍䈑ᷳ
ᶳ䓊䓇冒䘤⿏儎↢埨ᷳ䕭Ṣ炻℞儎↢埨橼䧵⸛
⛯䁢4㮓⋯炻᷎⛐䘤䓇↢埨⼴⸛⛯76⣑ⶎ⎛晐
㨇↮惵炻ᶨ䳬慵㕘≈⚆㈿埨⮷㜧喍(⊭㊔aspirin
ㆾclopidogrel)炻⎎ᶨ䳬⇯ᶵ≈⚆喍䈑炻䳸㝄
䘤䎦⛐⮯役4⸜䘬徥希忶䦳ᷕ炻ἧ䓐㈿埨⮷㜧
喍䈑䳬㚱庫Ỷ䘬儎↢埨⽑䘤䌯(4%㭼9%烊HR
= 0.51烊95%CI = 0.25–1.03烊P = 0.06)炻㇨㚱㠿
⠆⿏埨䭉ḳẞ⇯ᶵ䚠ᶲᶳ(HR = 1.02烊95%CI =
0.65–1.60烊P = 0.92)烊⛐㫉㕷佌↮㜸䔞ᷕ炻ᶵ婾
㗗䕭Ṣ⸜漉ˣ儎↢埨悐ỵˣἧ䓐⒒ᶨ䧖㈿埨⮷
㜧喍䈑ˣ≈喍⚆⍣䘬㗪攻ˣ䓂军儎悐⽖↢埨溆
(cerebral microbleeds)䘬㔠慷⣂⮉⍲ỵ伖䫱炻⛯
㰺㚱㖶栗䘬䳬攻ⶖ䔘ˤ䓙㬌⎗夳炻憅⮵㚱ἧ䓐
㈿埨⮷㜧喍䈑怑ㅱ䕯ᷳ䕭Ṣ炻⯙䬿䘤䓇忶冒䘤
⿏儎↢埨炻῀劍↢埨慷ᶵ⣏ᶼ枸㛇枸⼴ᶵⶖ炻
⼭埨⟲⏠㓞⼴炻㕤怑䔞㗪攻溆≈⚆㈿埨⮷㜧喍
䈑㗗⎗㍍⍿䘬ˤ
࡚ដȈ
14
1. 儎ᷕ桐䕭Ṣℵ㫉儎ᷕ桐䘬⌙晒⿏⡆檀炻⚈㬌
枸旚儎ᷕ桐⽑䘤䘬㱣䗪ㅱ⍲㖑ᶼ攟㛇忚埴ˤ
䎦昶㭝⛐枸旚朆⽫⚈⿏儎㠿⠆䘬⽑䘤㕡㱽
ᶲ炻⺢嬘ἧ䓐怑䔞䘬㈿埨⮷㜧喍䈑Ἦ枸旚仢
埨⿏儎ᷕ桐䘬⽑䘤␴℞Ṿ埨䭉ḳẞ䘬䘤䓇
(Class IˣLOE A)ˤ㟡㒂冐⸲娎槿䘬嫱㒂Ἦ怠
㑯喍䈑㱣䗪炻㚱ẍᶳ⚃䧖椾怠䘬㕡㱽⎗ὃ怠
㑯ˤ
(1) ἧ䓐aspirin (㭷㖍75–100㮓⃳)Ἦ旵Ỷ儎ᷕ
桐⽑䘤䘬㨇㚫(Class IˣLOE A)ˤ(䃉㚜≽)
(2) Clopidogrel⎗ẍἄ䁢枸旚儎ᷕ桐⽑䘤䘬㱣
䗪㕡㱽炻⮵㕤䃉㱽ἧ䓐aspirinㆾẍaspirin
㱣䗪ᶳṵ䘤䓇䵄⎰埨䭉ḳẞ(儎ᷕ桐ˣ⽫
倴㠿⠆ˣ㬣ṉ⍲慵⣏↢埨)䘬䕭Ṣ炻⎗
ẍ怠㑯ἧ䓐clopidogrel (Class IIaˣLOE
B-R)ˤ(䃉㚜≽)
(3) ⎰ Ἕ ἧ 䓐 a s p i r i n ( 㭷 㖍 5 0 㮓 ⃳ ) ␴ 攟 㓰
dipyridamole (200㮓⃳㭷㖍2㫉)⎗ẍ 䁢
㷃⮹儎ᷕ桐⽑䘤桐晒䘬㱣䗪㕡㱽(Class
IˣLOE B-R)ˤ(䃉㚜≽)
(4) Cilostazol⎗ẍἄ䁢枸旚儎ᷕ桐⽑䘤䘬喍
䈑烊⮵㕤䃉㱽ἧ䓐aspirinㆾẍaspirin㱣䗪
ᶳṵ䘤䓇䵄⎰埨䭉ḳẞ䘬䕭Ṣ炻㕤㌺昌
⽫堘䪕䕭⎚⼴炻⎗ἧ䓐cilostazol (100㮓⃳
㭷㖍ℑ㫉)㷃⮹儎ᷕ桐⽑䘤䘬桐晒(Class
IIaˣLOE B-R)炻䈡⇍㗗僼晁✳儎㠿⠆ㆾ
檀↢埨⿏桐晒䘬䕭Ṣ(Class IIaˣLOE A)ˤ
(䃉㚜≽)
2. 㚱TIA䘬䕭Ṣ⺢嬘ἧ䓐㈿埨⮷㜧喍䈑Ἦ枸旚
朆⽫⚈⿏TIA⺽䘤䘬儎ᷕ桐(Class IˣLOE
A)ˤ(䃉㚜≽)
3. 椾㫉ἧ䓐thienopyridine栆喍䈑㱣䗪䘬䕭Ṣ
⎗ẍ侫ㄖẍclopidogrelẋ㚧ticlopidine炻⚈䁢
clopidogrel䘬∗ἄ䓐㭼庫⮹(Class IIaˣLOE
B-NR)ˤ(䃉㚜≽)
4. 庽⹎≇傥⍿㎵ᷳ役㛇仢埨⿏儎ᷕ桐ㆾTIAᷳ
䕭Ṣ炻ᶼ⎰Ἕ仢埨“栙ℏ㿴㳩儎埨䭉㚱╖ᶨ
嗽䊡䨬忼70–99%炻⼿䴻慓ⷓ姽Ộ⇑䙲⍲桐
晒⼴炻⎰Ἕἧ䓐aspirin (㭷㖍100-325㮓⃳)⍲
 ߨЖӰ‫ܒ‬ીՖ‫ܒ‬သϛॳ‫ת‬Ֆω‫ݖ‬᛾‫ݽސ‬ᕛࡾЕ

clopidogrel (㭷㖍75㮓⃳) 90⣑炻℞⼴临䓐╖㕡 = 0.25–0.57烊P < 0.0001)ˤᶵ忶炻⛐䘤䕭6ᾳ㚰

㈿埨⮷㜧喍䈑(Class IIbˣLOE B-R)炻᷎惵⎰ ⼴䘬㬣ṉㆾ≇傥枸⼴㕡朊炻␴㛒䓐喍䘬佌䳬ᷳ
旵埨⡻㱣䗪ˣ埨傪㍏⇞ˣ埨䱾㍏⇞⍲䓇㳣✳ 攻᷎㛒↢䎦㚱シ佑䘬ⶖ嶅ˤaspirin晾䃞⮵㕤儎
ン婧㔜炻⎗ẍ枸旚仢埨⿏儎ᷕ桐⽑䘤ˤ(䃉㚜 悐ᷳ⢾䘬℞Ṿ悐ỵ㚱↢埨⿏⎰Ἕ䕯䘬⓷柴炻Ữ
≽) 㛒Ἕ䓐偅䳈(heparin)䘬佌䳬炻⇯㛒栗䣢㚱シ佑
5. 朆⽫⚈⿏仢埨⿏儎ᷕ桐䕭Ṣ炻⎰Ἕ栙ℏ⢾⣏ ⛘⡆≈ˤ䓙㬌䳸㝄䚳Ἦ炻怬㗗⺢嬘⛐仢埨⿏
埨䭉>50%ẍᶲ䊡䨬炻ㆾ㚱ℑ枭ẍᶲ⽫埨䭉䕦 儎ᷕ桐䘤䕭⼴⃀㖑ἧ䓐aspirinˤᶵ忶娚↮㜸ḇ
䕭⌙晒⚈⫸(⸜䲨≥65㬚ˣ檀埨⡻ˣ䱾⯧䕭ˣ 䘤䎦炻aspirin⮵ᶵ⎴♜慵䦳⹎䘬⿍⿏仢埨⿏儎
ㄊ⿏僶䕭ˣ␐怲≽傰䕦䕭ˣ仢埨⿏ᷕ桐䕭 ᷕ桐㕤㷃⮹仢埨⿏儎ᷕ桐⽑䘤ᶲ㚱ᶵ⎴䦳⹎䘬
⎚ˣ仢埨⿏⽫冇䕭⎚ˣㆾ㊩临㉥厠侭)炻⼿䴻 㓰㝄炻aspirin㕤庽⹎⍲ᷕ⹎♜慵⹎䘬䕭Ṣ⎗↮
慓ⷓ姽Ộ⇑䙲⍲桐晒⼴炻⎰Ἕἧ䓐cilostazol ⇍㷃⮹14⣑ℏ仢埨⿏ᷕ桐⽑䘤桐晒忼49%ẍ⍲
(㭷㖍200㮓⃳)⍲aspirin (㭷㖍81ㆾ100㮓⃳) 35%炻Ữ⮵㕤慵⹎♜慵⹎䘬䕭Ṣ⇯䃉栗叿枸旚
ㆾcilostazol (㭷㖍200㮓⃳)⍲clopidogrel (㭷㖍 ⽑䘤䘬㓰㝄炻⚈㬌㕤♜慵⿍⿏仢埨⿏儎ᷕ桐䕭
50ㆾ75㮓⃳)炻⎗ẍ枸旚仢埨⿏儎ᷕ桐⽑䘤 Ṣ㗗⏎ἧ䓐aspirin炻⊭㊔㗗⏎ἧ䓐庫檀䘬崟⥳
(Class IIbˣLOE B-R)ˤ(㕘⡆) ∹慷炻枰⎴㗪侫慷䕭Ṣ䘤䓇仢埨⿏⍲↢埨⿏ḳ
6. 攟㛇⎰Ἕἧ䓐aspirin⍲clopidogrel䚠庫㕤╖ᶨ ẞ桐晒䘬㔜橼⇑⺲炻Ἦ 㚨怑䔞䘬怠㑯ˤ
㈿埨⮷㜧喍䈑炻⎗傥㚫⡆≈↢埨桐晒(Class 军㕤㍍⍿朄傰埨㞻㹞妋∹㱣䗪(intravenous
IIIˣLOE A)ˤ(䃉㚜≽) thrombolysis, IVT)䘬䕭Ṣ炻➢㕤冐⸲娎槿䘬姕
7. 栙⢾≽傰∅暊(柠≽傰ㆾ傲㢶≽傰)⎰Ἕ仢埨 妰⍲⮎嫱慓⬠83炻⎬⚳㊯⺽⺢嬘ἧ䓐aspirin䘬㗪
⿏ᷕ桐ㆾTIA炻䁢枸旚ℵᷕ桐炻⎗怠㑯ἧ䓐 㨇䁢IVT㕥ㇻ䳸㜇⼴24⮷㗪84, 85ˤ军㕤䴎ḰIVT
㈿埨⮷㜧喍䈑ㆾ㈿ↅ埨喍䈑㱣䗪(Class IIbˣ ⼴24⮷㗪ℏ㗗⏎⎗䴎Ḱ㈿埨⮷㜧喍䈑炻䚖⇵ṵ
LOE B-R)ˤ(㕘⡆) 㰺㚱⭂婾ˤ㟡㒂杻⚳䘬╖ᶨ慓⬠ᷕ⽫䘬⚆㹗⿏
䘬䞼䨞 86 炻↮㜸㕤IVT⼴24⮷㗪ℏ䴎Ḱ㈿埨㞻
喍䈑䘬⬱ℐ⿏炻℞ᷕ51%ἧ䓐╖ᶨ㈿埨⮷㜧喍
ijįġࡨ‫ܒ‬ીՖ‫ܒ‬သϛॳ
䈑ˣ36%ἧ䓐暁㈿埨⮷㜧喍䈑ˣ13%ἧ䓐㈿ↅ
埨∹炻䘤䎦㍸㖑㈽喍᷎ᶵ㚫⡆≈䕯䉨⿏儎↢埨
ijįIJġ൐Ιο݈‫ת‬Ֆω‫ݖ‬᛾‫ސ‬ 䘬桐晒(OR = 0.85烊95%CI = 0.35–2.10)炻侴ᶼ㚱
⎋㚵㈿埨⮷㜧喍䈑ᷕ炻aspirin㗗䞼䨞㚨⺋ 庫⮹䘬↢埨⿏廱嬲(hemorrhagic transformation烊
㲃䘬喍䈑炻1997⸜⍲1999⸜⬴ㆸ䘬ℑ枭⣏✳ OR = 0.56烊95%CI = 0.35–0.89)炻Ữ娚䞼䨞㚱姙
晐㨇ˣ朆䚚ˣṳℍ⿏䞼䨞(Chinese Acute Stroke ⣂䃉㱽㌺昌䘬⸚㒦⚈⫸炻⚈㬌⮎⊁ᶲㅱ⯙䕭Ṣ
Trial [CAST]ˣInternational Stroke Trial [IST])䘬 ᾳ⇍ね㱩炻侫慷IVT⼴㈿埨⮷㜧喍䈑䘬㈽喍㗪
80, 81
䳸㝄栗䣢 炻⛐儎ᷕ桐䕭䘤⼴48⮷㗪ℏ䴎Ḱ 㨇ˤ
aspirin (300㮓⃳ㆾ160㮓⃳)傥ṃ⽖⛘㷃⮹儎㠿 ⮵㕤䃉㱽ἧ䓐aspirinㆾaspirin㱣䗪䃉㓰䘬䕭
⠆䕭Ṣ⛐䘤䕭⼴14⣑ℏ儎ᷕ桐䘬⽑䘤䌯␴㬣ṉ Ṣ炻㗗⏎傥ἧ䓐clopidogrel⍲dipyridamole炻忶
䌯炻⶚忼⇘䴙妰⬠ᶲ䘬シ佑炻侴ᶼᶵ㚫⡆≈↢ ⍣⮎嫱䴻槿㚱旸ˤ㚱䞼䨞栗䣢䴎䕭Ṣ300-600㮓
埨⿏儎ᷕ桐ˤ㔜⎰ᶲ徘CAST⍲IST䘬ᶨᾳ䴙⎰ ⃳䘬clopidogrel⎗ẍ⾓忇䘬㈹⇞埨⮷㜧ↅ普㓰
82
↮㜸栗䣢 炻㖑㛇ἧ䓐aspirin炻⎗ẍ栗叿⛘㷃 ㅱˤ⛐ᶨᾳ㚱20ỵ⿍⿏仢埨⿏儎ᷕ桐䕭Ṣ䘬⮷
⮹14⣑ℏ䘬仢埨⿏儎ᷕ桐⽑䘤炻侴ᶼ䗪㓰⛐攳 ✳䞼䨞ᷕ87炻㕤䘤䕭25ᾳ⮷㗪ℏ䴎Ḱ䕭Ṣ600㮓
⥳㱣䗪⼴䫔2-3⣑㚨䁢栗叿(HR = 0.37烊95%CI ⃳䘬clopidogrel炻᷎徥巐枸⼴炻䘤䎦忁ṃ䕭Ṣ

15

᷎㰺㚱↢䎦䤆䴻⬠ら⊾ㆾ㗗儎↢埨䘬ね㱩ˤ
⎎⢾ᶨᾳ喍䈑cilostazolḇ㚦⛐ᶨᾳ⮷✳晐
88
㨇娎槿ᷕ冯aspirin 㭼庫炻ℙ458ỵ⿍⿏仢埨⿏
儎ᷕ桐䕭Ṣ炻伶⚳⚳⭞堃䓇䞼䨞昊儎ᷕ桐慷堐
(National Institute of Health Stroke Scale, NIHSS)
≤ 15ˣᶼ㕤䘤䕭48⮷㗪ℏ↮⇍ἧ䓐cilostazolㆾ
aspirin炻䳸㝄栗䣢⛐䫔90⣑䘬列⤥枸⼴㭼䌯ℑ
侭䚠䔞炻侴ᶼᶵ列ḳẞ䘤䓇䌯炻⊭㊔儎ᷕ桐⍲
↢埨炻ℑ侭ḇ䃉ⶖ⇍ˤ㬌⢾炻cilostazol⛐⎎ᶨ
ᾳℙ507ᾳ㟰䘬⮷✳晐㨇娎槿ᷕ冯⬱ㄘ∹㭼庫
89
炻㇨㚱ᾳ㟰悥㚵䓐㈿埨⮷㜧ㆾ㈿埨㞻喍䈑炻
晐㨇↮惵军cilostazolㆾ⬱ㄘ∹炻䳸㝄栗䣢㖑㛇
儎ᷕ桐ら⊾䘬桐晒㰺㚱ⶖ⇍ˤẍᶲℑᾳ䞼䨞䘬
仢溆㗗ᾳ㟰庫⮹炻嫱㒂䫱䳂䔍䁢ᶵ嵛ˤ
ijįijġ‫ځ‬Ң‫ڍ‬ᆍο݈‫ת‬Ֆω‫ݖ‬᛾‫ސ‬
暁㈿埨⮷㜧喍䈑ἧ䓐㕤⿍⿏仢埨⿏儎ᷕ桐
90-93
䘬㓰㝄ḇ㚱䚠斄娎槿
晐㨇⣂ᷕ⽫娎槿炻㓞㟰⮵尉㗗24⮷㗪ᷳℏ⿍⿏
仢埨⿏儎ᷕ桐ˣ㌺昌㳣≽⿏儠偫忻㼘䖵ㆾ↢埨
⿏䕦䕭ˣᶼNIHSS ≤ 20䘬䕭Ṣ炻ℙ㚱543ỵ䕭
Ṣ↮ㆸḴ䳬炻ᶨ䳬㍍⍿㭷㖍100㮓⃳䘬aspirin╖
㕡㱣䗪7⣑炻᷎㕤7⣑⼴廱㎃ㆸ25㮓⃳䘬aspirin
≈ᶲ200㮓⃳䘬dipyridamole㭷㖍ℑ㫉䘬⎰Ἕ㱣
䗪炻⎎ᶨ䳬⇯㕤䫔1⣑⯙㍍⍿25㮓⃳䘬aspirin⍲
200㮓⃳䘬dipyridamole㭷㖍ℑ㫉䘬⎰Ἕ㱣䗪炻
姽Ộ䫔90⣑䘬≇傥枸⼴炻䳸㝄栗䣢⎰Ἕ㱣䗪䘬
䳬⇍㚱56%䕭Ṣ㚱列⤥䘬枸⼴炻侴ἧ䓐aspirin
╖㕡㱣䗪䘬䳬⇍㚱52%㚱列⤥枸⼴炻ℑ䳬䃉㖶
栗ⶖ䔘(䳽⮵ῤⶖ䔘4.1%烊95%CI = -4.5–12.6烊
P = 0.45)炻䵄⎰⿏ḳẞ䘤䓇䌯(㬣ṉˣ儎ᷕ桐ˣ
⽫倴㠿⠆⍲慵⣏↢埨)⛐㖑㛇ἧ䓐暁㈿埨⮷㜧喍
䈑䘬䳬⇍庫Ỷ炻Ữḇ㰺㚱䴙妰ⶖ䔘(HR = 0.73烊
95%CI = 0.44–1.19烊P = 0.20)ˤ
㚱3ᾳ⣏✳⿍⿏仢埨⿏儎ᷕ桐娎槿⎰Ἕἧ
91, 92, 94
䓐aspirin⍲clopidogrel
91
⍲伶⚳䘬FASTER娎槿 炻㓞㟰⮵尉㗗392ỵ㕤
24⮷㗪ẍℏ䘤䓇⿍⿏庽⽖仢埨⿏儎ᷕ桐(NIHSS
≤ 3)ㆾTIA䘬䕭Ṣ炻晐㨇↮惵⇘暁㈿埨⮷㜧喍
16
ߨЖӰ‫ܒ‬ીՖ‫ܒ‬သϛॳ‫ת‬Ֆω‫ݖ‬᛾‫ݽސ‬ᕛࡾЕ
䈑(clopidogrel㭷㖍75㮓⃳⍲aspirin㭷㖍81㮓⃳)
ㆾ╖㕡aspirin㱣䗪ℙ90⣑炻⮵㕤㰺㚱㍍⍿忶
clopidogrelㆾaspirin䘬䕭Ṣ炻椾㖍䘬⇅⥳∹慷
㗗clopidogrel 300㮓⃳炻侴aspirin㗗162㮓⃳ˤ
晾䃞忁ᾳ娎槿⚈㓞㟰⚘暋侴㍸㖑䳸㜇炻Ữ䳸
㝄栗䣢㕤儎ᷕ桐⿍⿏㛇ἧ䓐暁㈿埨⮷㜧喍䈑㚱
㷃⮹仢埨⿏ḳẞ䘤䓇䌯䘬嵐⊊炻⎰Ἕ喍䈑㱣䗪
䳬㗗7.1%炻aspirin╖㕡㱣䗪䳬㗗10.8%炻儎ᷕ
桐䘬桐晒ᶳ旵3.8%炻Ữⶖ䔘ᶵ栗叿(P = 0.19)ˤ
晾䃞䃉䕯䉨⿏䘬↢埨ḳẞ栗叿⡆≈(30.8%㭼
13.9%烊95%CI = 8.8–25.0烊P = 0.0001)炻Ữ慵
⣏↢埨ḳẞ㰺㚱ⶖ䔘炻⎒㚫⡆≈䲬1%䃉䴙妰
ⶖ䔘䘬䕯䉨⿏儎↢埨ˤ䫔Ḵᾳ娎槿㗗⛐ᷕ⚳忚
埴䘬CHANCE娎槿92炻㓞㟰⮵尉㗗5,170ỵ㕤24
⮷㗪ℏ䘤䓇⿍⿏庽⽖仢埨⿏儎ᷕ桐(NIHSS ≤ 3)
ㆾ侭㗗檀桐晒䘬TIA (ABCD2 ≥ 4)䘬40㬚ẍᶲ
䕭Ṣ炻晐㨇↮惵军╖ᶨaspirin㱣䗪(⇅⥳∹慷
90
ˤ℞ᷕEARLY 㗗ᶨᾳ 75–300㮓⃳炻℞⼴㭷㖍75㮓⃳)ㆾ暁㈿埨⮷㜧
喍䈑(aspirin≈ᶲclopidogrel⇅⥳∹慷300㮓⃳⍲
㭷㖍75㮓⃳)炻℞ᷕ暁㈿埨⮷㜧喍䈑䳬ἧ䓐ℑ
䧖㈿埨㜧喍䈑21⣑炻℞⼴ἧ䓐╖㕡clopidogrel
军90⣑炻䳸㝄栗䣢暁㈿埨⮷㜧喍䈑䳬⛐䫔90
⣑䘬儎ᷕ桐䘤䓇䌯㗗8.6%炻侴㍍⍿╖ᶨaspirin
㱣䗪䳬䘬䘤䓇䌯㗗11.7% (HR = 0.68烊95%CI =
0.57–0.81)炻㚱栗叿䘬⤥嗽烊ℑ䳬䘬↢埨⿏儎
ᷕ桐䘤䓇䌯悥㗗0.3%炻侴ᶼᷕ慵⹎↢埨⿏ḳẞ
㗗䚠Ụ䘬ˤCHANCE⎎⢾䘤䎦炻徥希忁ṃ䕭Ṣ
军1⸜㗪炻暁㈿埨⮷㜧喍䈑䳬ṵ䵕㊩庫Ỷ䘬儎
ᷕ桐䘤䓇䌯(10.6%㭼14.0%烊HR = 0.98烊95%CI
= 0.65–0.93烊P = 0.006)炻㫉↮㜸栗䣢 49炻栙ℏ
≽傰栗叿䊡䨬(50–99%)ᶼ↮惵军暁㈿埨⮷㜧喍
䈑䳬䘬䕭Ṣ炻䚠庫㕤╖㕡aspirin䳬炻㚱䚠⮵庫
ỶỮ䃉䴙妰ⶖ䔘䘬儎ᷕ桐⽑䘤䌯(HR = 0.79烊
95%CI = 0.47–1.32)炻⎎ᶨᾳ⼙⁷㫉↮㜸栗䣢
95
炻CHANCE娎槿ᷕ⼙⁷⏰䎦⣂䘤⿏儎ᷕ桐✳
ˤ䫔ᶨᾳ㗗≈㊧⣏ ン侭䘬儎ᷕ桐⽑䘤䌯檀㕤╖ᶨ儎ᷕ桐✳ン侭炻
ᶼ⣂䘤⿏儎ᷕ桐✳ン侭炻ἧ䓐暁㈿埨⮷㜧喍
䈑侭䘬儎ᷕ桐⽑䘤䌯栗叿Ỷ㕤ἧ䓐╖㕡aspirin
侭(HR = 0.5烊95%CI = 0.3–0.96烊P = 0.04)炻⍰
 ߨЖӰ‫ܒ‬ીՖ‫ܒ‬သϛॳ‫ת‬Ֆω‫ݖ‬᛾‫ݽސ‬ᕛࡾЕ
⣂䘤⿏儎ᷕ桐✳ン侭䘬ᷕ桐↮栆栗䣢檀忼65%
䘬䕭ṢⰔ㕤⣏埨䭉䱍䉨䠔⊾↮✳ˤAspirin≈
ᶲclopidogrel䘬暁㈿埨⮷㜧喍䈑䳬⎰ḇ㚦䴻⛐
93
CLAIR娎槿ᷕ㷔娎 炻㓞㟰⮵尉㗗100ỵ⿍⿏仢
埨⿏儎ᷕ桐ㆾTIAᶼ㚱儎≽傰ㆾ柠≽傰䊡䨬䘬
䕭Ṣ炻晐㨇↮惵军7⣑䘬aspirin≈ᶲclopidogrel
暁㈿埨⮷㜧喍䈑ㆾ㗗╖ᶨaspirin炻᷎ẍ䨧栙崭
枛㲊奨⮇⮵⮷㞻⫸妲嘇䘬⼙枧炻䘤䎦暁㈿埨
⮷㜧喍䈑䳬⇍䘬㞻⫸䘤䓇㭼䌯㗗33%炻侴╖ᶨ
aspirin䳬㗗65% (P = 0.022)ˤẍᶲ嫱㒂㊯↢暁㈿
埨⮷㜧喍䈑(aspirin≈ᶲclopidogrel)⛐⿍⿏仢埨
⿏儎ᷕ桐Ἕ㚱⎴“儎≽傰栗叿䊡䨬㗪炻⎗傥㚜
檀䘬㓰䙲 49, 93, 95ˤ⶚䘤堐䘬POINT娎槿㗗ᶨᾳ
94
⇵䝣⿏ˣ晐㨇ˣ暁䚚䘬⣂ᷕ⽫䞼䨞 炻ᷣ天䘬
䞼䨞䃎溆ḇ㗗暁㈿埨⮷㜧喍䈑⮵⿍⿏仢埨⿏
儎ᷕ桐ㆾTIA䕭Ṣ枸⼴䘬⼙枧炻Ữ䞼䨞㝞㥳冯
CHANCE娎槿㚱悐ấⶖ䔘(堐1)炻㓞㟰⮵尉㗗
12⮷㗪ℏ䘤ἄ䘬⿍⿏庽⽖仢埨⿏儎ᷕ桐ㆾTIA
䕭Ṣ炻晐㨇↮惵军clopidogrel (⇅⥳∹慷600㮓
⃳⍲㭷㖍∹慷75㮓⃳)ㆾ⬱ㄘ∹炻㇨㚱䕭Ṣ⛯
ἧ䓐㭷㖍50–325㮓⃳䘬aspirin (娎槿⺢嬘∹慷䁢
⇵5⣑㭷㖍162㮓⃳炻℞⼴㭷㖍81㮓⃳)炻᷎奨
⮇90⣑ℏ䘬儎ᷕ桐⽑䘤炻䳸㝄栗䣢暁㈿埨⮷㜧
喍䈑䳬䚠庫㕤╖㕡aspirin䳬炻⎗栗叿㷃⮹䵄⎰
⿏埨䭉⿏ḳẞ(HR = 0.75烊95%CI = 0.59–0.95烊
P = 0.02)炻↮⇍䚠⮵㷃⮹26%儎ᷕ桐⽑䘤桐晒
(HR = 0.74烊95%CI = 0.58–0.94烊P = 0.01)⍲28%
仢埨⿏儎ᷕ桐⽑䘤桐晒(HR = 0.72烊95%CI =
0.56–0.92烊P = 0.01)炻Ữ㚫栗叿⡆≈90⣑䘬慵
⣏↢埨ḳẞ(HR = 2.32烊95%CI = 1.10–4.87烊P =
0.02)ˤ䵄⎰CHANCE冯POINTℑ⣏娎槿炻怑䔞
䘬暁㈿埨⮷㜧喍䈑(aspirin≈ᶲclopidogrel)ἧ䓐
㗪攻ㅱ性⃵崭忶21⣑炻军㕤㗗⏎傥ℵ忚ᶨ㬍䷖
䞕暁㈿埨⮷㜧喍䈑䘬ἧ䓐㗪攻烎㟡㒂CHANCE
娎槿䘬㗪攻庠↮㜸 96炻仢埨⿏儎ᷕ桐⽑䘤ḳẞ
㚱檀忼3/4䘤䓇㕤ᷕ桐⼴䫔1忙炻ᶼ䚠庫㕤╖ᶨ
aspirin䳬炻暁㈿埨⮷㜧喍䈑㇨㷃⮹䘬仢埨⿏儎
ᷕ桐ḳẞ炻㕤ᷕ桐10⣑⼴᷎㰺㚱ⶖ䔘ˤPOINT
94
娎槿憅⮵㗪攻庠䘬↮㜸ḇ䘤䎦 炻⛐ᷕ桐⼴7⣑
ℏ炻暁㈿埨⮷㜧喍䈑⎗栗叿㷃⮹仢埨⿏ḳẞ䘤
䓇䌯(HR = 0.74烊95%CI = 0.55–0.99烊P = 0.04)炻
Ữ䃉㱽㷃⮹䫔8-90⣑䘬仢埨⿏ḳẞ䘤䓇䌯(HR
= 1.03烊95%CI = 0.70–1.53烊P = 0.88)ˤᶨ枭⊭
⏓FASTERˣCHANCE⍲POINT䫱3ᾳ娎槿䘬
䴙⎰↮㜸炻⮯ᷕ桐⼴㗪攻庠↮䁢ᶱ㭝 97炻⌛䫔
0-10⣑ˣ11-21⣑⍲22-90⣑炻↮㜸ᶵ⎴㗪攻㭝
䘬暁㈿埨⮷㜧喍䈑䗪㓰炻栗䣢暁㈿埨⮷㜧喍䈑
㷃⮹ᷕ桐⼴10⣑ℏ䘬儎ᷕ桐⽑䘤䌯䳽⮵ῤ忼2%
(OR = 0.64烊95%CI = 0.55–0.76)炻䫔11-21⣑䘬
桐晒ᶳ旵⇯㰺㚱栗叿ⶖ䔘(OR = 0.73烊95%CI =
0.47–1.13)炻军㕤䫔22-90⣑炻暁㈿埨⮷㜧⸦᷶
ᶵ⎗傥㚱⤥嗽(OR = 1.47烊95%CI = 0.84–2.56)ˤ
侴䳸⎰CHANCE冯POINTℑ⣏娎槿䘬䴙⎰↮㜸
栗䣢 98炻㕤晐㨇↮惵⼴21⣑ℏ炻暁㈿埨⮷㜧喍
䈑⎗栗叿㷃⮹慵⣏仢埨⿏ḳẞ䘬䘤䓇䌯(5.2%
㭼7.8%烊HR = 0.66烊95%CI = 0.56–0.77烊P <
0.001)炻侴ᶼ⤥嗽ᷣ天Ἦ冒㕤晐㨇↮惵⼴10
⣑ℏ(4.7%㭼7.1%烊HR = 0.65烊95%CI = 0.55–
0.77烊P < 0.001)炻军㕤䫔22军90⣑炻CHANCE
␴POINT娎槿悥㰺㚱忼⇘栗叿䴙妰ⶖ䔘炻侴↮
㭝䴙妰⼴䘬慵⣏↢埨ḳẞ炻晾䃞暁㈿埨⮷㜧
喍䈑䳬⛐POINT娎槿ᷕ䘬䫔22-99⣑檀㕤aspirin
䳬炻Ữ㰺㚱忼⇘栗叿ⶖ䔘(0.6%㭼0.2%烊HR =
2.63烊95%CI = 0.93–7.40烊P = 0.07)ˤ
晾䃞clopidogrel≈ᶲaspirin䘬暁㈿埨⮷
㜧喍䈑䳬⎰䘬䗪㓰㚱䞼䨞嫱㒂㓗㊩炻天㲐
シclopidogrelẋ嫅䘬➢⚈⣂✳⿏ḇ㚫⼙枧暁
㈿埨⮷㜧喍䈑䘬䗪㓰炻㚱䞼䨞㊯↢炻ἧ䓐
clopidogrel枸旚儎ᷕ桐䘬䕭Ṣ炻ⷞ㚱CYP2C19
⣙⍣≇傥䫱ỵ➢⚈(loss-of-function alleles烉*2ˣ
*3ˣ*8)侭㚱庫檀䘬儎ᷕ桐䘤䓇䌯(RR = 1.92烊
95%CI = 1.57–2.35烊P < 0.001)99ˤCHANCE娎槿
栗䣢 100炻⣙⍣≇傥䫱ỵ➢⚈(*2ˣ*3)㚫⼙枧暁
㈿埨⮷㜧喍䈑䘬䗪㓰(P = 0.02 for interaction)炻
䚠庫㕤╖ᶨaspirin䳬炻暁㈿埨⮷㜧喍䈑䃉㱽旵
Ỷ㬌栆䕭Ṣ䘬儎ᷕ桐䘤䓇䌯(HR = 0.93烊95%CI
= 0.69–1.26)炻⍵ᷳ炻暁㈿埨⮷㜧喍䈑⇯⎗栗
叿旵Ỷᶵⷞ⣙⍣≇傥䫱ỵ➢⚈侭䘬儎ᷕ桐桐晒
17
 ߨЖӰ‫ܒ‬ીՖ‫ܒ‬သϛॳ‫ת‬Ֆω‫ݖ‬᛾‫ݽސ‬ᕛࡾЕ

堐1ˢCHANCE娎槿冯POINT娎槿㭼庫堐

娎槿⎵䧙 CHANCE POINT

䞼䨞姕妰 ⣂ᷕ⽫ˣ晐㨇ˣ暁䚚 ⣂ᷕ⽫ˣ晐㨇ˣ暁䚚
䲵ℍ㧁㸾/㕷佌 檀桐晒㙓㗪⿏儎仢埨(ABCD2 ≥ 4)ㆾ庽 檀桐晒㙓㗪⿏儎仢埨(ABCD2 ≥ 4)ㆾ庽
⹎仢埨⿏儎ᷕ桐(NIHSS ≤ 3)炻䘤䕭⮷ ⹎仢埨⿏儎ᷕ桐(NIHSS ≤ 3)炻䘤䕭⮷
㕤24⮷㗪/ᷕ⚳ 㕤12⮷㗪/㫸伶䁢ᷣ
䲵ℍṢ㔠 5,170 4,881
䞼䨞↮䳬 DAPT vs aspirin DAPT vs aspirin
䴎喍㕡㱽 DAPT䳬 DAPT䳬
Day 1烉clopidogrel 300㮓⃳ + aspirin Day 1烉clopidogrel 600㮓⃳ + aspirin
75-300㮓⃳烊 50-325㮓⃳
D 2-21烉clopidogrel 75㮓⃳/㖍 + aspirin D2-90烉clopidogrel 75㮓⃳/㖍 + aspirin
㮓⃳/㖍烊 50-325㮓⃳/㖍
Day 22-90烉clopidogrel 75㮓⃳/㖍
Aspirin䳬 Aspirin䳬
Day 1烉75-300㮓⃳烊 Day 1-90烉50-325㮓⃳/㖍
Day 2-90烉75㮓⃳/㖍
徥巐㗪攻 90㖍 90㖍
ᷣ天䗪㓰䳪溆 儎ᷕ桐ḳẞ烉8.2%㭼11.7%烊HR = 䵄⎰⿏仢埨⿏ḳẞ烉5%㭼6.5%烊HR =
0.68 (0.57-0.81) 0.75 (0.59-0.95)
℞Ṿ䗪㓰䳪溆 䵄⎰⿏仢埨⿏ḳẞ烉8.4%㭼11.9%烊 儎ᷕ桐烉4.8%㭼6.4%烊HR = 0.74
䳸㝄 HR = 0.69 (0.58-0.82) (0.58-0.94)
仢埨⿏儎ᷕ桐烉7.9%㭼11.4%烊HR = 仢埨⿏儎ᷕ桐烉4.6%㭼6.3%烊HR =
0.67 (0.56-0.81) 0.72 (0.56-0.92)
㬣ṉ烉0.4%㭼0.4%烊HR = 0.97 (0.40- 㬣ṉ烉0.7%㭼0.5%烊HR = 1.51 (0.73-
2.33) 3.13)
⬱ℐ⿏䳪溆 慵⣏↢埨ḳẞ烉0.2%㭼0.2%烊HR = 慵⣏↢埨ḳẞ烉0.9%㭼0.4%烊HR =
0.94 (0.24-3.79) 2.32 (1.10-4.87)
↢埨⿏儎ᷕ桐烉0.3%㭼0.3%烊HR = ↢埨⿏儎ᷕ桐烉0.2%㭼0.1%烊HR =
1.01 (0.38-2.70) 1.68 (0.40-7.03)
䕯䉨⿏儎ℏ↢埨烉0.1%㭼0.1%烊HR =
1.01 (0.14-7.14)
DAPT: dual antiplatelets.

(HR = 0.51烊95%CI = 0.35–0.75)ˤ 㧁㸾㱣䗪(⊭⏓╖ᶨclopidogrelㆾ⎰Ἕaspirin冯

dipyridamole)炻䳸㝄栗䣢䳬攻䘬䗪㓰㰺㚱栗叿
ijįĴġ‫ځ‬Ңέᆍο݈‫ת‬Ֆω‫ݖ‬᛾‫ސ‬ ⶖ䔘炻侴ᶼᶱ㈿埨⮷㜧喍䈑䳬㚱庫⣂䘬慵⣏
㚱斄⿍⿏仢埨⿏儎ᷕ桐䕭Ṣ⎴㗪ἧ䓐ᶱ ↢埨ḳẞ(OR = 2.54烊95%CI = 2.05–3.16烊P <
䧖㈿埨⮷㜧喍䈑炻䚖⇵䞼䨞栗䣢㬌ἄ㱽㰺㚱 0.0001)ˤ
㭼㧁㸾㱣䗪㚜⤥ˤTARDIS㗗ᶨᾳ晐㨇冐⸲娎
槿 101炻娚娎槿⮯⿍⿏仢埨⿏儎ᷕ桐ㆾTIA䘬䕭 ijįĵġ‫ڏ‬тο݈‫ת‬Ֆω‫ݖ‬᛾‫ސ‬
Ṣ㕤䘤䕭⼴48⮷㗪ℏ晐㨇↮惵军ᶱ㈿埨⮷㜧喍 Ticagrelorḇ㗗ᶨᾳP2Y12 ADP㍍⍿☐䘬
䈑䳬⇍(⊭⏓aspirin㭷㖍75㮓⃳炻clopidogrel㭷 ⎗微⿏㊖㈿∹炻Ữᶵ⎴㕤clopidogrel䘬㗗ᶵ暨
㖍75㮓⃳⍲dipyridamole㭷㖍300–400㮓⃳)ㆾ 天䴻忶ẋ嫅㳣⊾ˤSOCRATES娎槿㗗ᶨᾳ晐

18
 ߨЖӰ‫ܒ‬ીՖ‫ܒ‬သϛॳ‫ת‬Ֆω‫ݖ‬᛾‫ݽސ‬ᕛࡾЕ
㨇ˣ暁䚚䘬⣂⚳⭞娎槿 102炻䞼䨞⮵尉㗗24⮷㗪
ℏ䘤䓇䘬⿍⿏庽⽖仢埨⿏儎ᷕ桐(NIHSS ≤ 5)ㆾ
檀桐晒䘬TIA (ABCD2 ≥ 4ㆾ⎴“儎≽傰栗叿䊡
䨬)䕭Ṣ炻晐㨇↮惵军ticagrelor (⇅⥳∹慷180
㮓⃳⍲90㮓⃳㭷㖍Ḵ㫉)ㆾaspirin (⇅⥳∹慷300
㮓⃳⍲㭷㖍100㮓⃳)炻⎬䳬⛯≈ᶲ䚠⮵ㅱ䘬⬱
ㄘ∹炻᷎奨⮇䫔90⣑䘬儎ᷕ桐⽑䘤炻㓞㟰Ṣ㔠
䁢13,199ỵ炻晾䃞⇅䳂娎槿䳪溆(⊭⏓儎ᷕ桐ˣ
⽫倴㠿⠆⍲㬣ṉ)㰺㚱忼⇘栗叿䴙妰ⶖ䔘(HR =
0.89烊95%CI = 0.78–1.01烊P = 0.07)炻Ữ㗗㫉䳂
娎槿䳪溆ˬ仢埨⿏儎ᷕ桐˭忼⇘栗叿䘬桐晒ᶳ
旵(HR = 0.87烊95%CI = 0.76–1.00烊P = 0.046)炻
⚈㬌ticagrelorṵ塓夾䁢℟㚱枸旚仢埨⿏儎ᷕ桐
⽑䘤䘬㼃≃ˤSOCRATES娎槿䘬㫉↮㜸栗䣢
103
炻⤪儎ᷕ桐⎰Ἕ⎴“埨䭉栗叿䱍䉨䠔⊾䊡䨬
(≥ 50%)炻ticagrelorᶵ⎗栗叿旵Ỷ⇅䳂娎槿䳪
溆(HR = 0.68烊95%CI = 0.53–0.88烊P = 0.003)炻
ᶼ⎗旵Ỷ仢埨⿏儎ᷕ桐桐晒(HR= 0.73烊95%CI
= 0.56–0.95烊P = 0.02)ˤ⎎⢾SOCRATES䘬Ṇ㳚
104
㕷佌↮㜸栗䣢 炻 䚠庫㕤aspirin炻ticagrelor傥
栗叿㷃⮹Ṇ㳚Ṣ䘬⇅䳂娎槿䳪溆(HR = 0.81烊
95%CI = 0.67–0.99烊P = 0.04)炻ᶼ㷃⮹仢埨⿏
儎ᷕ桐(HR = 0.81烊95%CI = 0.66–0.99烊P =
0.04)ˤ侴ticagrelor㗗⏎怑⎰冯aspirinἝ䓐ẍ枸
105
旚儎ᷕ桐⽑䘤烎㫉↮㜸 栗䣢㕤ᷕ桐⇵1忙㚦
䴻ἧ䓐aspirin䘬䕭Ṣ炻⤪塓↮惵军ticagrelor䳬
⇍炻⇯䚠庫㕤两临ἧ䓐aspirin䘬䳬⇍炻ᶵ⎗
栗叿㷃⮹⇅䳂娎槿䳪溆(HR = 0.76烊95%CI =
0.61–0.95烊P = 0.02)炻ḇ⎗栗叿旵Ỷ仢埨⿏儎
ᷕ桐⽑䘤桐晒(HR = 0.78烊95%CI = 0.62–0.99烊
P = 0.04)炻侴ᶼ慵⣏↢埨ḳẞ桐晒᷎㛒栗叿⡆
≈(HR = 1.58烊95%CI = 0.68–3.65烊P = 0.28)ˤ
106
THALES㗗ᶨᾳ⣏✳晐㨇娎槿 炻㓞㟰⮵尉㗗
庽⹎⿍⿏仢埨⿏儎ᷕ桐(NIHSS ≤ 5)ㆾ檀桐晒
TIA (ABCD2 ≥ 6ㆾ⎴“儎≽傰栗叿䊡䨬)䕭Ṣ炻
枸妪㓞㟰㔠䲬13,000Ṣ炻⮯䘤䕭24⮷㗪ℏ䘬
䕭Ṣ晐㨇↮惵军ticagrelor䳬(⇅⥳∹慷180㮓⃳
⍲90㮓⃳㭷㖍Ḵ㫉)ㆾ⬱ㄘ∹䳬炻ℑ䳬⛯ἧ䓐
aspirin (⇅⥳∹慷300–325㮓⃳⍲㭷㖍75–100㮓
⃳)炻徥希㗪攻䁢30⣑炻⇅䳂娎槿䳪溆䁢儎ᷕ桐
冯㬣ṉ炻㫉䳂娎槿䳪溆䁢仢埨⿏儎ᷕ桐⍲mRS
> 1炻娚娎槿⮯㍸ὃaspirin≈ᶲticagrelor䘬暁㈿
埨⮷㜧喍䈑䳬⎰⮵儎ᷕ桐䘬䗪㓰㗗⏎⃒㕤╖ᶨ
aspirinἧ䓐ˤ
⎎⢾ᶨᾳ㱣䗪朆⽫⚈⿏⿍⿏仢埨⿏儎
ᷕ桐䘬暁㈿埨⮷㜧喍䈑䘬䳬⎰㗗aspirin≈ᶲ
cilostazol 107炻ADS娎槿⮯朆⽫⚈⿏⿍⿏仢埨⿏
儎ᷕ桐䘬䕭Ṣ㕤䘤䕭⼴48⮷㗪ℏ晐㨇↮惵军暁
㈿埨⮷㜧喍䈑䳬⇍(n = 600炻⇵14㖍ἧ䓐aspirin
㭷㖍81–200㮓⃳≈ᶲcilostazol㭷㖍200㮓⃳炻
䫔15⣑军3ᾳ㚰ἧ䓐╖ᶨcilostazol㭷㖍200㮓⃳)
ㆾaspirin䳬⇍(n = 601炻⇵14㖍ἧ䓐aspirin㭷㖍
81–200㮓⃳炻䫔15⣑军3ᾳ㚰ἧ䓐╖ᶨcilostazol
㭷㖍200㮓⃳)炻娚娎槿NIHSS score䘬ᷕỵ㔠
2↮炻䗪㓰䘬⇅䳂娎槿䳪溆䁢14⣑ℏ䘬䤆䴻⬠䕯
䉨ら⊾ˣ䕯䉨⿏⽑䘤⿏儎ᷕ桐ㆾTIAḳẞ炻䳸
㝄栗䣢ℑ䳬攻᷎䃉栗叿ⶖ䔘(11%㭼11%烊HR =
1.04烊95%CI = 0.72–1.50烊P = 0.829)炻栙ℏ↢埨
ḳẞ䘬䘤䓇䌯ḇ㰺㚱栗叿ⶖ䔘(暁㈿埨⮷㜧喍䈑
䳬㭼╖㕡aspirin䳬䁢0.3%㭼0.2%烊P = 0.624)炻
⚈㬌䚖⇵㰺㚱嫱㒂㓗㊩㕤朆⽫⚈⿏⿍⿏仢埨⿏
儎ᷕ桐䘬䕭Ṣ⎰Ἕἧ䓐aspirin⍲cilostazol䘬⤥
嗽ˤ
ijįĶġᓗ૕‫תৢݧ‬Ֆω‫ݖ‬᛾‫ސ‬ġ
ᶨᾳphase III䘬⿍⿏仢埨⿏儎ᷕ桐㱣䗪䞼
108
䨞 炻ẍ態噳䘥IIb/IIIa receptor㈹⇞∹abciximab
㱣䗪䜉愺㗪儎ᷕ桐(wake-up stroke)炻䳸㝄⌣栗
䣢䚠庫㕤⬱ㄘ∹炻ἧ䓐abciximab䘬䕭Ṣ↢埨
䘬桐晒㚫⡆≈ˤ⎎⢾ᶨᾳ⣂ᷕ⽫晐㨇娎槿䔞ᷕ
109
炻ℑ䳬䞼䨞⮵尉悥⛐㍍⍿IVT㱣䗪24⮷㗪⼴
㍍⍿⎋㚵aspirin㱣䗪炻℞ᷕᶨ䳬⛐攳⥳IVT⼴
90↮揀ℏ䴎Ḱ朄傰㲐⮬aspirinˤỮ㗗娚䞼䨞䘤
䎦炻ἧ䓐朄傰㲐⮬aspirin㱣䗪䘬䳬⇍㚱庫檀䘬
䕯䉨⿏儎↢埨䘤䓇䌯(4.3%㭼1.6%烊P = 0.04)ˤ
晾䃞⛐ᶨᾳ䲵ℍ260ỵ48⮷㗪ℏ⿍⿏仢埨⿏儎
ᷕ桐䕭Ṣ䘬晐㨇娎槿 110炻ẍ㧁㸾㱣䗪䁢➢䢶炻
≈ᶲtirofiban᷎ᶵ㚫⡆≈↢埨桐晒炻Ữ䚖⇵ṵᶵ
19
 ߨЖӰ‫ܒ‬ીՖ‫ܒ‬သϛॳ‫ת‬Ֆω‫ݖ‬᛾‫ݽސ‬ᕛࡾЕ
⺢嬘ẍ朄傰㲐⮬㈿埨⮷㜧喍䈑㱣䗪⿍⿏仢埨⿏
儎ᷕ桐ˤ㬌⢾炻態噳䘥IIb/IIIa receptor㈹⇞∹㕤
≽傰埨㞻䦣昌㱣䗪ᷕ䘬奺刚⇯㛒㚱⭂婾炻⛐ᶨ
111
ᾳ⚆㹗⿏䘬䞼䨞ᷕ栗䣢 炻≽傰埨㞻䦣昌㱣䗪
Ἕ䓐⋲∹慷䘬abciximab (0.125㮓⃳/℔㕌)ᶵ㚫
⡆≈䕯䉨⿏儎↢埨䘬桐晒ˤ⎎ᶨᾳ⚆㹗⿏䘬䞼
䨞112炻↮㜸120ỵ⚈傲㢶ㆾ➢⸽≽傰旣⠆䘬⿍⿏
仢埨⿏儎ᷕ桐䕭Ṣ(⸛⛯NIHSS䁢32↮)炻⎰Ἕ
態噳䘥IIb/IIIa receptor㈹⇞∹(⊭㊔abciximabㆾ
tirofiban)⍲≽傰ℏ埨㞻㹞妋㱣䗪炻栗䣢≽傰ㆸ
≇ℵ忂䌯䁢81%炻䕯䉨⿏儎↢埨䘬㭼ἳ䁢9%炻
3ᾳ㚰⼴䘬mRS 0-3䘬㭼ἳ䁢41%ˤ⎎ᶨᾳ⇵䝣
⿏䞼䨞⇯栗䣢 113炻㕤≽傰䱍䉨䠔⊾↮✳䘬⿍⿏
仢埨⿏儎ᷕ桐䕭Ṣ炻⎰Ἕ≽傰埨㞻䦣昌㱣䗪⍲
tirofiban炻⎗栗叿㷃⮹ỷ昊ᷕ䘤䓇儎↢埨桐晒
(OR = 0.38烊95%CI = 0.18–0.81)炻ᶼ⎗ẍ㓡┬攟
㛇≇傥枸⼴(OR = 3.05烊95%CI = 0.97–9.60)ˤ態
噳䘥IIb/IIIa receptor㈹⇞∹⛐⿍⿏仢埨⿏儎ᷕ桐
㱣䗪䘬奺刚⭂ỵ暨天㛒Ἦ㚜⣂⣏✳䞼䨞㍸ὃ忚
ᶨ㬍䘬嫱㒂ˤ
ijįķġ๖፣
朆⽫⚈⿏⿍⿏仢埨⿏儎ᷕ桐䘤䓇⼴48⮷㗪
ẍℏ炻䴎Ḱ⎋㚵庫檀⇅⥳∹慷䘬aspirin炷160-
300㮓⃳炸⎗ẍ栗叿⛘㷃⮹㬣ṉ䌯⍲ᶵ列枸⼴炻
⤥嗽⎗傥㗗Ἦ冒㕤㷃⮹Ḯ㖑㛇䘬儎ᷕ桐⽑䘤烊
嫱㒂ḇ栗䣢㕤䫎⎰娎槿䲵ℍ㧁㸾䘬⿍⿏庽⽖仢
埨⿏儎ᷕ桐ㆾ檀桐晒䘬TIA䕭Ṣ炻⃀㖑ᶼ䞕㛇
⎰Ἕἧ䓐aspirin冯clopidogrel炻⎗栗叿㷃⮹儎ᷕ
桐⽑䘤炻᷎ᶵ㚫⡆≈儎↢埨⍲慵⣏↢埨ḳẞ䘤
䓇䌯ˤ
࡚ដȈ
1. ⛐⿍⿏仢埨⿏儎ᷕ桐䘤ἄ48⮷㗪ℏ炻⤪䃉㈿
埨⮷㜧喍䈑䤩⽴䕯炻⺢嬘ἧ䓐aspirin炻⤪䕭
Ṣ㍍⍿朄傰rt-PA㱣䗪炻⎗㕤㲐⮬䳸㜇24⮷㗪
⼴ἧ䓐㈿埨⮷㜧喍䈑(Class IˣLOE A)ˤ(㚜
≽)
2. 朆⽫⚈⿏檀桐晒TIA (ABCD2 score ≥ 4)ㆾ⿍
20
⿏庽⽖仢埨⿏儎ᷕ桐(NIHSS ≤ 3)䘤ἄ24⮷㗪
ℏ炻⤪䃉㈿埨⮷㜧喍䈑䤩⽴䕯炻⺢嬘⎰Ἕἧ
䓐aspirin⍲clopidogrel炻ἧ䓐㗪攻⎗军21⣑
(Class IˣLOE A)ˤ(㚜≽)
3. 䃉㱽ἧ䓐aspirin䘬朆⽫⚈⿏⿍⿏仢埨⿏儎
ᷕ桐䕭Ṣ炻⎗侫ㄖἧ䓐clopidogrel (Class
IIaˣLOE C-LD)ㆾcilostazol (Class IIaˣLOE
B-R)ˤ(㚜≽)
4. 㕤朆⽫⚈⿏仢埨⿏儎ᷕ桐⿍⿏㛇ἧ䓐aspirin/
extended-release dipyridamole (25㮓⃳/200 㮓
⃳㭷㖍ℑ㫉)炻⎗傥㷃⮹㔜橼ᶵ列枸⼴䘬㨇㚫
(Class IIbˣLOE B-R)ˤ(䃉㚜≽)
5. ⛐⿍⿏仢埨⿏儎ᷕ桐䘤ἄ⼴炻⎒天䕭Ṣ㚱㨇
㚫㍍朄傰rt-PA㱣䗪炻ᶵㅱ侫ㄖẍaspirin㈿埨
⮷㜧喍䈑Ἦẋ㚧(Class IIIˣLOE B-R)ˤ(䃉㚜
≽)
6. 朆⽫⚈⿏⿍⿏仢埨⿏儎ᷕ桐䕭Ṣᶵ⺢嬘ἧ䓐
ᶱ㈿埨⮷㜧喍䈑㱣䗪(aspirinˣclopidogrel⍲
dipyridamole) (Class IIIˣLOE B-R)ˤ(㕘⡆)
ĴįġॶԩသϛॳႱ٩
⣏悐ấ㚱斄aspirin䓐㕤⽫埨䭉䕦䕭⇅䳂
枸旚䘬䞼䨞 114-117 炻栗䣢aspirin⮵儎ᷕ桐䘤䕭
䌯㰺㚱⼙枧ˤ℞ᷕ⊭⏓Ḯ6ᾳ娎槿ℙ95,000
ỵᾳ㟰䘬䴙⎰↮㜸(Antithrombotic Trialists’
Collaboration)117炻aspirin䚠庫㕤⬱ㄘ∹炻䃉㱽㷃
⮹儎ᷕ桐䘬䘤䓇䌯炻ᶼ㚫⡆≈↢埨ḳẞˤ2011
⸜ᶨᾳ⊭⏓Ḯ9ᾳ娎槿 118炻ℙ100,076ỵᾳ㟰䘬
䴙⎰↮㜸炻aspirin晾䃞⎗ẍ㷃⮹ᷣ天⽫埨䭉ḳ
ẞ(RR = 0.88烊95%CI = 0.83–0.94)⍲仢埨⿏儎ᷕ
桐(RR = 0.86烊95%CI = 0.75–0.98)炻Ữ⌣㚫⡆≈
↢埨⿏儎ᷕ桐(RR = 1.36烊95%CI = 1.01–1.82)⍲
慵⣏↢埨ḳẞ(RR = 1.66烊95%CI = 1.41–1.95)ˤ
忁ṃ䞼䨞䳸㝄栗䣢炻ᶨ凔⣏䛦ἧ䓐aspirin㰺㚱
栗叿䘬㔜橼⤥嗽ˤ
Ữ㗗⛐2005⸜䘤堐䘬WHS娎槿 119 炻⊭⏓
39,876ᾳ⽆㛒㚱⽫埨䭉䕦䕭⍲儎ᷕ桐䕭⎚䘬45
㬚ẍᶲ⤛⿏炻晐㨇↮惵军aspirin (100㮓⃳㭷ℑ
 ߨЖӰ‫ܒ‬ીՖ‫ܒ‬သϛॳ‫ת‬Ֆω‫ݖ‬᛾‫ݽސ‬ᕛࡾЕ

㖍ᶨ㫉)ㆾ⬱ㄘ∹炻䴻忶10⸜徥希炻䘤䎦⎗ẍṃ 1.01–1.29)炻↮㜸℞ᷕ䘬㬣ṉ⍇⚈炻䘤䎦aspirin
⽖㷃⮹9%䘬⽫埨䭉䕦䕭䚠⮵桐晒炻㰺㚱䴙妰⬠ 䳬㚱庫檀䘬䗴䕯䚠斄㬣ṉ桐晒(HR = 1.31烊
ⶖ䔘炻Ữ㗗⌣⎗ẍ栗叿⛘㷃⮹17%䘬儎ᷕ桐䚠 95%CI = 1.01–1.56)炻忚ᶨ㬍↮㜸䗴䕯䚠斄㬣ṉ
⮵桐晒炻℞ᷕ⊭㊔㷃⮹24%仢埨⿏儎ᷕ桐䘬䚠 ⍇⚈䘬䗴䕯栆⇍栗䣢炻aspirin䳬㚱庫檀䘬⣏儠
⮵桐晒炻侴ᶼ↢埨⿏儎ᷕ桐䘬桐晒᷎ᶵ㚫栗叿 䚜儠䗴䕯䚠斄䘬㬣ṉ桐晒(HR = 1.77烊95%CI
⡆≈炻栗䣢aspirin⎗ẍ㷃⮹⤛⿏伡か椾㫉儎ᷕ = 1.02–3.06)ˤ⎎⢾ᶨᾳ⇅䳂枸旚䘬晐㨇娎槿
桐䘬桐晒炻Ữ㚫ṃ⽖⡆≈偫儠忻慵⣏↢埨䘬䘤 ASCEND 130炻⮯≥ 40㬚䘬䱾⯧䕭䕭Ṣ晐㨇↮惵
䓇䌯(RR = 1.40烊95%CI = 1.07–1.83烊P = 0.02)ˤ 军aspirin䳬(㭷㖍100㮓⃳)ㆾ⬱ㄘ∹䳬炻⸛⛯徥
⛐⎴䭯⟙⏲ᷕ䳸⎰⣂䭯娎槿ᷕ䘬⤛⿏ᾳ㟰㇨  希㗪攻䁢7.4⸜炻䘤䎦aspirin䳬㚱庫Ỷ䘬♜慵埨
119
䘬䴙⎰↮㜸ḇ栗䣢 炻aspirin⎗㷃⮹⤛⿏伡か 䭉ḳẞ䘤䓇䌯(8.5%㭼9.6%烊RR = 0.88烊95%CI
椾㫉儎ᷕ桐䘬桐晒炻㫉↮㜸䘤䎦⤛⿏㚱⽫埨䭉 = 0.79–0.97烊P = 0.01)炻Ữaspirin䳬ḇ㚱庫檀䘬
䕦䕭⌙晒⚈⫸炻⤪㚜⸜㛇ˣ檀埨⡻ˣ檀埨傪ˣ 慵⣏↢埨ḳẞ䘤䓇䌯(4.1%㭼3.2%烊RR = 1.29烊
䱾⯧䕭ˣ10⸜䘬⽫埨䭉䕦䕭檀桐晒ˣㆾảℑᾳ 95%CI = 1.09–1.52烊P = 0.003)炻⚈㬌aspirin㇨㷃
⌙晒⚈⫸侭炻ἧ䓐aspirin⎗ẍ栗叿⛘㷃⮹儎ᷕ ⮹䘬慵⣏⽫埨䭉ḳẞ䘬⣏悐↮⤥嗽塓慵⣏↢埨
桐䘬桐晒炻䈡⇍㗗䱾⯧䕭Ṣ⍲10⸜⽫埨䭉䕦䕭 ⿏ḳẞ㇨㉝㴰炻侴ᶼ≈ℍ娎槿⇵㍐Ộ䁢庫檀⽫
檀桐晒侭ˤ⚈㬌⣂ᾳ憅⮵⇅䳂枸旚䘬㱣䗪㊯⺽ 埨䭉ḳẞ桐晒䘬䕭Ṣ炻慵⣏↢埨⿏ḳẞ䘬䘤䓇
㊯↢120-122炻⤪㝄㍐Ộ䕭Ṣ䘬10⸜⽫埨䭉䕦䕭桐 䌯ḇ晐ᷳᶲ⋯ˤ⎎⢾ᶨᾳ⇅䳂枸旚䘬晐㨇娎槿
晒≥ 10%炻㕤堉慷䙲嗽冯桐晒⼴炻⎗ẍ侫ㄖἧ 㗗ARRIVE 131炻䞼䨞⮵尉䁢㌺昌檀↢埨桐晒⍲
䓐aspirinἮ枸旚椾㫉⽫埨䭉䕦䕭ˤ 䱾⯧䕭⼴炻10⸜ⅈ⽫䕭桐晒ṳ㕤10–20%䘬䓟⿏
Ữ㗗憅⮵㛒㚦儎ᷕ桐䘬䱾⯧䕭䕭Ṣ㇨忚埴 (≥ 50㬚)ㆾ⤛⿏(≥ 60㬚)炻ᾳ㟰䘬⸛⛯10⸜桐晒
䘬䞼䨞⌣㊯↢123, 124炻ἧ䓐aspirin᷎ᶵ傥栗叿㷃 䲬14%炻℞ᷕ䲬65%䘬ᾳ㟰㚵䓐檀埨⡻㱣䗪䓐
⮹䵄⎰⿏埨䭉ḳẞ儎ᷕ桐䘤䓇䌯ˤᶨᾳ⊭⏓7ᾳ 喍炻⮯ᾳ㟰晐㨇↮惵军aspirin䳬(㭷㖍100㮓⃳)
124
娎槿炻ℙ11,618ỵ䱾⯧䕭䕭Ṣ䘬䴙⎰↮㜸 炻 ㆾ⬱ㄘ∹䳬炻⸛⛯徥希㗪攻䁢60ᾳ㚰炻䳸㝄䘤
䘤䎦ἧ䓐aspirin⎗ẍṃ⽖㷃⮹䲬9%䘬ᷣ天⽫埨 䎦ℑ䳬䘬⽫埨䭉ḳẞ䘬䘤䓇䌯㰺㚱ⶖ䔘(4.29%
䭉ḳẞ(RR = 0.91烊95%CI = 0.82–1.00)炻Ữ㗗 㭼4.48%烊HR = 0.96%烊95%CI = 0.81–1.13烊P =
᷎䃉㱽㷃⮹儎ᷕ桐䘬䘤䓇䌯(RR = 0.83烊95%CI 0.604)炻ᶼaspirin䳬㚱栗叿庫檀䘬偫儠忻↢埨ḳ
= 0.63–1.10)ˤ⚈㬌炻aspirin㕤⽫埨䭉䕦䕭⇅䳂 ẞ䘤䓇䌯(0.97%㭼0.46%烊HR = 2.11烊95%CI =
枸旚䘬奺刚⍲ἧ䓐㗪㨇ṵᶵ㶭㤂ˤ⯌℞㗗晐叿 1.36–3.28烊P = 0.0007)ˤ
㗪ẋ䘬忚⯽炻忶⍣㔠⋩⸜攻炻⎬⚳憅⮵⽫埨䭉 ⛐2019⸜炻ᶨᾳ⊭⏓13ᾳἧ䓐aspirin㕤⇅
䕦䕭⌙晒⚈⫸䘬㍏⇞⍲喍䈑ἧ䓐䘬㘖⍲炻ἧ⎬ 䳂枸旚䘬冐⸲娎槿132-144 ᷳ䴙⎰↮㜸145炻㓞䲵Ḯ
⚳儎ᷕ桐䘤䓇䌯徸⸜ᶳ旵125-128炻⎗傥攻㍍⼙枧 ℙ164,225ỵ㰺㚱㖶栗⽫埨䭉䕦䕭䘬⍿娎侭炻℞
aspirin㕤⽫埨䭉䕦䕭⇅䳂枸旚䘬奺刚ˤ ᷕ47.2%䁢䓟⿏ˣ枸㛇10⸜⽫埨䭉桐晒䁢10.2%
129
ASPREE㗗ᶨᾳ⣏✳䘬晐㨇冐⸲娎槿 炻 (2.6–30.9%)炻⸛⛯徥希5⸜炻ᷣ天奨⮇䳸㝄䁢䵄
⮵尉㗗ᶵ㚦㚱⽫埨䭉䕦䕭⎚ˣᶼ⸜䲨≥ 70㬚ẍ ⎰⿏⽫埨䭉ḳẞ(⊭⏓⽫埨䭉㬣ṉˣ朆农␥⿏⽫
ᶲ䘬‍⹟侩Ṣℙ19,114Ṣ炻晐㨇↮惵军aspirin 倴㠿⠆ˣ朆农␥⿏ᷕ桐)ˤ䳸㝄䘤䎦ἧ䓐aspirin
䳬(㭷㖍100㮓⃳)ㆾ⬱ㄘ∹䳬炻⸛⛯徥希㗪攻 傥⣈㚱㓰㷃⮹䵄⎰⿏⽫埨䭉ḳẞ(HR = 0.89烊
䁢4.7⸜炻℞ᷕ䲬74%䘬ᾳ㟰㚱檀埨⡻䕭⎚炻䲬 95%CI = 0.84–0.94)炻ḇ⎗旵Ỷ仢埨⿏ᷕ桐忼
19%䘬䕭Ṣ㚱䗴䕯䕭⎚炻䳸㝄䘤䎦aspirin䳬䘬 19% (1.27%㭼1.47%烊HR = 0.81烊95%CI = 0.76–
㬣ṉ䌯栗叿檀㕤⬱ㄘ∹䳬(HR = 1.14烊95%CI = 0.81)炻Ữ枰㲐シ℞旵Ỷᷳ䳽⮵桐晒䁢0.19%

21
 ߨЖӰ‫ܒ‬ીՖ‫ܒ‬သϛॳ‫ת‬Ֆω‫ݖ‬᛾‫ݽސ‬ᕛࡾЕ
(0.06–0.30%)炻ẋ堐⸛⛯天⛐540ỵ䕭Ṣἧ䓐
aspirinㇵ傥⼿⇘1㫉ᷕ桐旵Ỷ䘬ᾅ嬟㓰㝄(暨㱣
䗪䕭Ṣ㔠˳number need to treat, NNT˴= 540)ˤ
䚠⮵Ἦ婒炻⛐忁ṃ⍿娎侭幓ᶲἧ䓐aspirin䚠庫
㕤⬱ㄘ∹炻㚫栗叿⡆≈↢埨ḳẞ炻⊭⏓慵⣏↢
埨(HR = 1.43烊95%CI = 1.30–1.56烊暨塓 ⭛䕭
Ṣ㔠˳number need to harm, NNH˴= 210)ˣ栙
ℏ↢埨(HR = 1.34烊95%CI = 1.14–1.57烊NNH =
927)ˣẍ⍲♜慵儠偫忻↢埨(HR = 1.56烊95%CI
= 1.38–1.78烊NNH = 334)ˤ劍ẍ⋩⸜⽫埨䭉桐
晒10%䁢↯溆炻⛐Ỷ桐晒㕷佌(< 10%)ᷕ炻ἧ䓐
aspirin晾⎗旵Ỷ䵄⎰⿏⽫埨䭉ḳẞ(HR = 0.87烊
95%CI = 0.79–0.95)炻Ữ旵Ỷ仢埨⿏ᷕ桐䘬㓰䙲
᷎ᶵ栗叿(HR = 0.83烊95%CI = 0.69–1.06)ˣᶼ
ṵ㚫栗叿⡆≈慵⣏↢埨ˣ栙ℏ↢埨⍲儠偫忻↢
埨烊⛐檀桐晒㕷佌(ʁ10%)侭炻旵Ỷ䵄⎰⿏⽫
埨䭉ḳẞ(HR = 0.91烊95%CI = 0.84–0.98)ㆾ仢埨
⿏ᷕ桐(HR = 0.88烊95%CI = 0.76–1.02)䘬䦳⹎ḇ
栆Ụ炻Ữ栙ℏ↢埨桐晒⇯㗗ᶵ栗叿⛘㍸檀(HR =
1.19烊95%CI = 0.89–1.60)烊⛐㛒㚦ᷕ桐䘬䱾⯧
䕭Ṣᷕ炻⎴㧋⎗ẍ旵Ỷ䵄⎰⿏⽫埨䭉ḳẞ(HR =
0.90烊95%CI = 0.82–1.00)炻䃉㱽栗叿⛘旵Ỷ仢
埨⿏ᷕ桐(HR = 0.70烊95%CI = 0.36–1.37)炻侴㚫
⡆≈慵⣏↢埨(HR = 1.29烊95%CI = 1.11–1.51)⍲
栙ℏ↢埨(HR = 1.35烊95%CI = 1.05–1.75)ˤ
146炻
⛐2019⸜ḇ䘤堐Ḯ⎎ᶨ䭯䴙⎰↮㜸
⚾㍊妶⛐忶⼨㰺㚱䕯䉨⿏⽫埨䭉䕦䕭⎚侭炻ἧ
䓐Ỷ∹慷(㭷㖍< 100㮓⃳) aspirin忈ㆸ栙ℏ↢埨
䘬⌙晒炻㓞䲵Ḯ13ᾳ娎槿ℙ134,446ỵ⍿娎侭炻
䳸㝄䘤䎦Ỷ∹慷aspirin䚠庫㕤⮵䄏䳬炻㚫栗叿
⡆≈ảỽ栙ℏ↢埨䘬桐晒(HR = 1.37烊95%CI =
1.13–1.66)炻㎃䬿崟Ἦ䚠䔞⛐㭷1,000Ṣἧ䓐㚫
䘤䓇2ᾳ栙ℏ↢埨烊劍䳘↮栙ℏ↢埨䘬✳ン炻
⇯ẍ䠔儎兄ᶳ(subdural)ㆾ䠔儎兄⢾(epidural)↢
埨䘬桐晒㚨檀(HR = 1.53烊95%CI = 1.08–2.18)炻
儎ℏ↢埨㫉ᷳ(HR = 1.23烊95%CI = 0.98–1.54)烊
⛐㫉㕷佌↮㜸䔞ᷕ炻ẍṆ㳚䕭Ṣㆾ幓橼岒慷㊯
㔠庫Ỷ侭(body mass index˳BMI˴< 25)桐晒庫
檀(HR = 1.84烊95%CI = 1.04–3.27)ˤ忁ṃ䞼䨞
22
栗䣢炻⮵㕤㰺㚱㖶䡢⽫埨䭉䕦䕭䕭⎚䘬䕭Ṣ
Ἦ婒炻aspirin䘬⇅䳂枸旚㓰㝄᷎ᶵ㖶䡢炻Ữ⌣
㚫㖶栗⡆≈儎↢埨桐晒炻䈡⇍㗗⛐Ṇ㳚㕷佌ㆾ
BMI庫Ỷ侭炻⛐忁ṃṢ幓ᶲἧ䓐天㟤⢾⮷⽫ˤ
Aspirinḇ㚦⛐␐怲埨䭉䕦䕭䘬䕭Ṣ 忶
娎槿ˤ⛐ᶨᾳ⊭⏓9ᾳ晐㨇娎槿䘬䴙⎰↮㜸
147
炻ℙ㚱3,019ỵ䕯䉨⿏ㆾ䃉䕯䉨⿏␐怲埨䭉
䕦䕭䕭Ṣ炻䳸㝄栗䣢ἧ䓐aspirin⎗㷃⮹36%朆
农㬣⿏儎ᷕ桐䘬䚠⮵桐晒(RR = 0.64烊95%CI =
0.42–0.99烊P = 0.04)炻ᶼᶵ㚫⡆≈慵⣏↢埨ḳẞ
䘬桐晒ˤỮ⛐AAA娎槿ᷕ148炻3,350ỵ䃉䕯䉨⿏
␐怲≽傰䕦䕭䕭Ṣ(巅偙㊯㔠炻˳ankle-brachial
index, ABI˴≤ 0.95炻⸛⛯0.86)炻晐㨇↮惵军ἧ
䓐aspirinㆾ⬱ㄘ∹炻徥巐8.2⸜⼴炻䘤䎦aspirin
䃉㱽㷃⮹⽫倴㠿⠆ㆾ儎ᷕ桐ˤ⎎⢾炻POPADA
娎槿㗗ᶨᾳ暁䚚䘬晐㨇䞼䨞 149 炻㓞抬Ḯ1,276
ỵ䱾⯧䕭ᶼ䃉䕯䉨⿏␐怲≽傰䕦䕭(ABI ≤ 0.99)
䘬䕭Ṣ炻忶⍣ḇ䃉⽫埨䭉䕦䕭䕭⎚炻晐㨇䴎Ḱ
aspirinㆾ⬱ㄘ∹炻䳸㝄栗䣢aspirin䃉㱽㷃⮹㔜
橼䘬⽫埨䭉ḳẞ⍲ⅈ䉨埨䭉䕦䕭ㆾ儎ᷕ桐㇨农
㬣ṉ炻ḇ䃉㱽㷃⮹农㬣⿏儎ᷕ桐炻晾䃞⎗旵Ỷ
29%朆农㬣⿏儎ᷕ桐䘬䚠⮵桐晒炻Ữ䳸㝄᷎ᶵ
栗叿(RR = 0.71烊95%CI = 0.44–1.14烊P = 0.15)ˤ
⚈㬌炻⛐䃉䕯䉨䘬␐怲≽傰䕦䕭䕭Ṣ炻aspirin
᷎䃉栗叿䙲嗽ˤ
娎 ⛐CAPRIE娎槿ᷕ13炻䕯䉨⿏␐怲≽傰䕦䕭
䕭Ṣ(6%㚦㚱仢埨⿏儎ᷕ桐䕭⎚)䘬↮㜸䳸㝄⇯
栗䣢炻clopidogrel䳬㭷⸜䘬㔜橼⽫埨䭉ḳẞ䘤
䓇䌯㗗3.71%炻侴aspirin䳬䁢4.86%炻䚠⮵桐晒
ᶳ旵23.8% (95%CI = 8.9–36.2烊P = 0.0028)炻Ữ
㗗忁ᾳ⤥嗽ᷣ天㗗Ἦ冒㕤⽫倴㠿⠆⍲℞Ṿ埨䭉
ḳẞ䚠斄㬣ṉ䘬ᶳ旵炻儎ᷕ桐䘬䘤䓇䌯㰺㚱ⶖ
⇍ˤ
㚱斄㕤cilostazol⛐枸旚椾㫉儎ᷕ桐䘬嫱
㒂炻ᶨᾳ⊭⏓Ḯ3,782ỵ␐怲≽傰䕦䕭䕭Ṣ䘬
䴙⎰↮㜸栗䣢 150炻cilostazolἧ䓐⛐␐怲≽傰䕦
䕭ᾳ㟰⎗ẍ栗叿⛘㷃⮹儎埨䭉ḳẞ䘬桐晒(RR
= 0.58烊95%CI = 0.43–0.78烊P < 0.001)炻侴ᶼᶵ
㚫⡆≈♜慵↢埨䘬Ἕ䘤䕯(RR = 1.00烊95%CI =
 ߨЖӰ‫ܒ‬ીՖ‫ܒ‬သϛॳ‫ת‬Ֆω‫ݖ‬᛾‫ݽސ‬ᕛࡾЕ
0.66–1.51烊P = 0.996)ˤ忁ᾳ↮㜸䘬ᷣ天娎槿㗗
CASTLE娎槿炻ℙ1,435ỵ䕯䉨⿏␐怲≽傰䕦䕭
䕭Ṣ炻℞ᷕ90%㰺㚱儎ᷕ桐䕭⎚炻晐㨇↮惵军
cilostazol㭷㖍ℑ㫉100㮓⃳ㆾ⬱ㄘ∹炻䴻忶36
ᾳ㚰⼴炻㚱崭忶60%䘬䕭Ṣ 㬊娎槿䓐喍炻⌣
⎗䘤䎦cilostazol䘬儎ᷕ桐䘤䓇䌯㗗3.2%炻侴⬱
ㄘ∹䳬⇯㗗6.1% (P < 0.05)炻栗䣢cilostazol⛐䕯
䉨⿏䘬␐怲≽傰䕦䕭䘬䕭Ṣ⎗傥⎗ẍ枸旚儎ᷕ
桐ˤ
151
㕤2002⸜䘬ᶨ枭ᶾẋ䞼䨞䳸㝄栗䣢 炻䃉
䕯䉨⿏柠≽傰䊡䨬㗗儎ᷕ桐䘬檀桐晒㕷佌炻䊡
䨬䦳⹎0–49%侭䘬⎴“儎ᷕ桐㭷10⸜䘤䓇䌯䁢
5.7%炻侴䊡䨬䦳⹎50–99%侭䘬⎴“儎ᷕ桐㭷
10⸜䘤䓇䌯檀忼9.3%ˤ⎎ᶨᶾẋ䞼䨞徥希䃉䕯
䉨⿏柠≽傰䊡䨬䦳⹎忼60–99%䘬䕭Ṣ炻⸛⛯徥
巐34ᾳ㚰炻䘤䎦㭷⸜⎴“儎㠿⠆ㆾTIA䘤䓇䌯
㗗3.1%152ˤ役⸜晐叿喍䈑㱣䗪䘬忚⯽炻ἳ⤪旵
埨⡻喍䈑ˣstatin⍲㈿埨⮷㜧喍䈑䫱炻䃉䕯䉨⿏
䘬柠≽傰䊡䨬䘤䓇儎ᷕ桐䘬㨇㚫⶚徸⸜ᶳ旵153,
154 154
ˤ⛐2010⸜䘬ᶨᾳᶾẋ䞼䨞 炻奨⮇䃉䕯䉨
⿏柠≽傰䊡䨬50–99%䘬䕭Ṣ䘤䓇埨䭉ḳẞ䘬桐
晒炻℞ᷕ90%ẍᶲ㚵䓐㈿埨⮷㜧喍䈑炻80%ẍ
ᶲ㚵䓐statin⍲旵埨⡻喍炻䞼䨞栗䣢㭷⸜⎴“仢
埨⿏儎ᷕ桐ㆾTIA䘬䘤䓇䌯㗗2.1%ˤ⛐ᶨᾳ奨
155
⮇⿏䞼䨞 炻徥巐477ỵ柠≽傰䊡䨬70-99%䘬
䕭Ṣ军⮹2⸜炻ἧ䓐㈿埨⮷㜧喍䈑傥栗叿庫Ỷ儎
ᷕ桐桐晒(HR = 0.45烊95%CI = 0.31–0.66)ˤ⚈㬌
憅⮵䃉䕯䉨⿏柠≽傰䊡䨬䘬䕭Ṣ炻昌Ḯ㱣䗪儎
ᷕ桐⌙晒⚈⫸⢾炻ḇㅱ䴎Ḱaspirin枸旚儎ᷕ桐
121, 156
ˤ Attack (UK-TIA) aspirin trial: Final results. J
⚈㬌㰢⭂㗗⏎ἧ䓐aspirinἮ ⇅䳂枸旚ᷳ
⇵炻ㅱ娚冯䕭Ṣ娛䳘⛘妶婾⇑⺲⼿⣙ᷳ⼴ℵ  1054.
㰢⭂炻䈡⇍㗗⽫埨䭉䕦䕭⌙晒⚈⫸䃉㱽㍏⇞列
157
⤥䘬䕭Ṣ ˤ
࡚ដ
1. 40-70㬚䘬≽傰䠔⊾埨䭉䕦䕭檀桐晒䕭Ṣ炻
㕤堉慷䙲嗽冯桐晒⼴炻⎗ẍ侫ㄖἧ䓐Ỷ∹慷
aspirin (㭷㖍75–100㮓⃳)Ἦ枸旚椾㫉⽫埨䭉
䕦䕭ㆾ儎ᷕ桐(Class IIbˣLOE A)ˤ(㚜≽)
2. 70㬚ẍᶲ䘬䕭Ṣᶵㅱⷠ夷ἧ䓐aspirinἮ枸
旚椾㫉⽫埨䭉䕦䕭ㆾ儎ᷕ桐(Class IIIˣLOE
B-R)ˤ(㕘⡆)
3. 檀↢埨桐晒䕭Ṣᶵㅱⷠ夷ἧ䓐aspirinἮ枸
旚椾㫉⽫埨䭉䕦䕭ㆾ儎ᷕ桐(Class IIIˣLOE
C-LD)ˤ(㕘⡆)
4. 㕤䕯䉨⿏␐怲埨䭉䕦䕭䘬䕭Ṣ⎗ἧ䓐㈿埨⮷
㜧喍䈑(⤪aspirinˣclopidogrelㆾcilostazol)Ἦ
枸旚椾㫉儎ᷕ桐(Class IIaˣLOE B-R)ˤ(㚜
≽)
5. か㚱䃉䕭⽝⿏ℏ柠≽傰䊡䨬(≥ 50%)䘬䕭Ṣ炻
⺢嬘䧵㤝㱣䗪埨䭉䕦䕭⌙晒⚈⫸炻᷎⎗侫ㄖ
ἧ䓐㈿埨⮷㜧喍䈑Ἦ枸旚椾㫉儎ᷕ桐(Class
IˣLOE C-LD)ˤ(㚜≽)
୤ՃМᝦ
1. Antithrombotic Trialists C. Collaborative
meta-analysis of randomised trials of
antiplatelet therapy for prevention of death,
myocardial infarction, and stroke in high risk
patients. BMJ 2002; 324: 71-86.
2. Algra A, van Gijn J. Aspirin at any dose
above 30 mg offers only modest protection
after cerebral ischaemia. J Neurol Neurosurg
Psychiatry 1996; 60: 197-199.
3. Farrell B, Godwin J, Richards S, Warlow C.
The United Kingdom Transient Ischaemic
Neurol Neurosurg Psychiatry 1991; 54: 1044-
4. Collaborative overview of randomised
trials of antiplatelet therapy--i: Prevention
of death, myocardial infarction, and stroke
by prolonged antiplatelet therapy in various
categories of patients. Antiplatelet trialists’
collaboration. BMJ 1994; 308: 81-106.
5. Johnson ES, Lanes SF, Wentworth CE, 3rd,
23
 ߨЖӰ‫ܒ‬ીՖ‫ܒ‬သϛॳ‫ת‬Ֆω‫ݖ‬᛾‫ݽސ‬ᕛࡾЕ
Satterfield MH, Abebe BL, Dicker LW. A
metaregression analysis of the dose-response
effect of aspirin on stroke. Arch Intern Med
1999; 159: 1248-1253.
6. The DUTCH TIA trial study group. A
comparison of two doses of aspirin (30 mg
vs. 283 mg a day) in patients after a transient
ischemic attack or minor ischemic stroke. N
Engl J Med 1991; 325: 1261-1266.
7. G o r e l i c k P B , We i s m a n S M . R i s k o f
hemorrhagic stroke with aspirin use: An
update. Stroke 2005; 36: 1801-1807.
8. He J, Whelton PK, Vu B, Klag MJ. Aspirin
and risk of hemorrhagic stroke: A meta-
analysis of randomized controlled trials.
JAMA 1998; 280: 1930-1935.
9. Campbell CL, Smyth S, Montalescot G,
Steinhubl SR. Aspirin dose for the prevention
of cardiovascular disease: A systematic
review. JAMA 2007; 297: 2018-2024.
10. Serebruany VL, Steinhubl SR, Berger PB, et
al. Analysis of risk of bleeding complications
after different doses of aspirin in 192,036
patients enrolled in 31 randomized controlled
trials. Am J Cardiol 2005; 95: 1218-1222.
11. 僛⋺ᷕͤ͜΁Ρ͜Ϋ⥼⒉Ể烉㖍㛔僛⋺
ᷕ㱣䗪ͤ͜΁Ρ͜Ϋ2015˳徥墄2019⮦
⾄˴ ˤ㟒⺷Ể䣦⋼␴ẩ䓣烊2019ˤ
12. Weisman SM, Graham DY. Evaluation of
the benefits and risks of low-dose aspirin in
the secondary prevention of cardiovascular
and cerebrovascular events. Arch Intern Med
2002; 162: 2197-2202.
13. CAPRIE steering committee. A randomised,
blinded, trial of clopidogrel versus aspirin in
patients at risk of ischaemic events (CAPRIE).
Lancet 1996; 348: 1329-1339.
14. Sacco RL, Diener HC, Yusuf S, et al. Aspirin
and extended-release dipyridamole versus
24
clopidogrel for recurrent stroke. N Engl J Med
2008; 359: 1238-1251.
15. Gotoh F, Tohgi H, Hirai S, et al. Cilostazol
stroke prevention study: A placebo-controlled
double-blind trial for secondary prevention of
cerebral infarction. J Stroke Cerebrovasc Dis
2000; 9: 147-157.
16. Shinohara Y, Katayama Y, Uchiyama S, et al.
Cilostazol for prevention of secondary stroke
(CSPS 2): An aspirin-controlled, double-
blind, randomised non-inferiority trial. Lancet
Neurol 2010; 9: 959-968.
17. Uchiyama S, Shinohara Y, Katayama Y, et al.
Benefit of cilostazol in patients with high risk
of bleeding: Subanalysis of Cilostazol Stroke
Prevention Study 2. Cerebrovasc Dis 2014;
37: 296-303.
18. Kim JS, Kwon SU, Uchiyama S. Cilostazol
research in Asia: Can it be applied to
European and American patients? Int J Stroke
2015; 10 Suppl 1: 1-9.
19. Gent M, Blakely JA, Easton JD, et al. The
Canadian American Ticlopidine Study (CATS)
in thromboembolic stroke. Lancet 1989; 1:
1215-1220.
20. Hass WK, Easton JD, Adams HP, Jr., et al.
A randomized trial comparing ticlopidine
hydrochloride with aspirin for the prevention
of stroke in high-risk patients. Ticlopidine
Aspirin Stroke Study group. N Engl J Med
1989; 321: 501-507.
21. Gorelick PB, Richardson D, Kelly M, et
al. Aspirin and ticlopidine for prevention
of recurrent stroke in black patients: A
randomized trial. JAMA 2003; 289: 2947-
2957.
22. Kernan WN, Ovbiagele B, Black HR,
et al. Guidelines for the prevention of
stroke in patients with stroke and transient
 ߨЖӰ‫ܒ‬ીՖ‫ܒ‬သϛॳ‫ת‬Ֆω‫ݖ‬᛾‫ݽސ‬ᕛࡾЕ
ischemic attack: A guideline for healthcare
professionals from the American Heart
Association/American Stroke Association.
Stroke 2014; 45: 2160-2236.
23. Wallentin L, Becker RC, Budaj A, et al.
Ticagrelor versus clopidogrel in patients with
acute coronary syndromes. N Engl J Med
2009; 361: 1045-1057.
24. James SK, Storey RF, Khurmi NS, et al.
Ticagrelor versus clopidogrel in patients
with acute coronary syndromes and a history
of stroke or transient ischemic attack.
Circulation 2012; 125: 2914-2921.
25. Mega JL, Close SL, Wiviott SD, et al.
Cytochrome p450 genetic polymorphisms
and the response to prasugrel: Relationship
to pharmacokinetic, pharmacodynamic, and
clinical outcomes. Circulation 2009; 119:
2553-2560.
26. Ogawa H, Isshiki T, Kimura T, et al. Effects
of CYP2C19 allelic variants on inhibition
of platelet aggregation and major adverse
cardiovascular events in Japanese patients
with acute coronary syndrome: The PRASFIT-
ACS study. J Cardiol 2016; 68: 29-36.
27. Wiviott SD, Braunwald E, McCabe CH, et al.
Prasugrel versus clopidogrel in patients with
acute coronary syndromes. N Engl J Med
2007; 357: 2001-2015.
28. Bavishi C, Panwar S, Messerli FH, Bangalore
S. Meta-analysis of comparison of the newer
oral P2Y12 inhibitors (prasugrel or ticagrelor)
to clopidogrel in patients with non-ST-
elevation acute coronary syndrome. Am J
Cardiol 2015; 116: 809-817.
29. Kitazono T, Ikeda Y, Nishikawa M, Yoshiba
S, Abe K, Ogawa A. Influence of cytochrome
p450 polymorphisms on the antiplatelet
effects of prasugrel in patients with non-
cardioembolic stroke previously treated with
clopidogrel. J Thromb Thrombolysis 2018;
46: 488-495.
30. The ESPS group. The European Stroke
Prevention Study (ESPS): Principal end-
points. Lancet 1987; 2: 1351-1354.
31. Diener HC, Cunha L, Forbes C, Sivenius
J, Smets P, Lowenthal A. European Stroke
Prevention Study. 2. Dipyridamole and
acetylsalicylic acid in the secondary
prevention of stroke. J Neurol Sci 1996; 143:
1-13.
32. Group ES, Halkes PH, van Gijn J, Kappelle
LJ, Koudstaal PJ, Algra A. Aspirin plus
dipyridamole versus aspirin alone after
cerebral ischaemia of arterial origin (ESPRIT):
Randomised controlled trial. Lancet 2006;
367: 1665-1673.
33. Diener HC, Bogousslavsky J, Brass LM, et
al. Aspirin and clopidogrel compared with
clopidogrel alone after recent ischaemic
stroke or transient ischaemic attack in high-
risk patients (MATCH): Randomised, double-
blind, placebo-controlled trial. Lancet 2004;
364: 331-337.
34. B h a t t D L , F o x K A , H a c k e W, e t a l .
Clopidogrel and aspirin versus aspirin alone
for the prevention of atherothrombotic events.
N Engl J Med 2006; 354: 1706-1717.
35. Investigators SPS, Benavente OR, Hart RG,
et al. Effects of clopidogrel added to aspirin
in patients with recent lacunar stroke. N Engl
J Med 2012; 367: 817-825.
36. Lee M, Saver JL, Hong KS, Rao NM, Wu YL,
Ovbiagele B. Risk-benefit profile of long-term
dual- versus single-antiplatelet therapy among
patients with ischemic stroke: A systematic
review and meta-analysis. Ann Intern Med
2013; 159: 463-470.
25
 ߨЖӰ‫ܒ‬ીՖ‫ܒ‬သϛॳ‫ת‬Ֆω‫ݖ‬᛾‫ݽސ‬ᕛࡾЕ
37. Kwon SU, Cho Y-J, Koo J-S, et al. Cilostazol
prevents the progression of the symptomatic
intracranial arterial stenosis: The multicenter
double-blind placebo-controlled trial of
cilostazol in symptomatic intracranial arterial
stenosis. Stroke 2005; 36: 782-786.
38. Kwon SU, Hong K-S, Kang D-W, et al.
Efficacy and safety of combination antiplatelet
therapies in patients with symptomatic
intracranial atherosclerotic stenosis. Stroke
2011; 42: 2883-2890.
39. Uchiyama S, Sakai N, Toi S, et al. Final
results of cilostazol-aspirin therapy against
recurrent stroke with intracranial artery
stenosis (CATHARSIS). Cerebrovasc Dis
Extra 2015; 5: 1-13.
40. Toyoda K, Uchiyama S, Yamaguchi T, et al.
Dual antiplatelet therapy using cilostazol for
secondary prevention in patients with high-
risk ischaemic stroke in japan: A multicentre,
open-label, randomised controlled trial.
Lancet Neurol 2019; 18: 539-548.
41. Gorelick PB, Wong KS, Bae HJ, Pandey DK.
Large artery intracranial occlusive disease:
A large worldwide burden but a relatively
neglected frontier. Stroke 2008; 39: 2396-
2399.
42. De Silva DA, Woon FP, Pin LM, Chen CP,
Chang HM, Wong MC. Intracranial large
artery disease among OCSP subtypes in
ethnic South Asian ischemic stroke patients. J
Neurol Sci 2007; 260: 147-149.
43. Wang Y, Zhao X, Liu L, et al. Prevalence and
outcomes of symptomatic intracranial large
artery stenoses and occlusions in China: The
Chinese Intracranial Atherosclerosis (CICAS)
study. Stroke 2014; 45: 663-669.
44. Chimowitz MI, Lynn MJ, Howlett-Smith H,
et al. Comparison of warfarin and aspirin for
26
symptomatic intracranial arterial stenosis. N
Engl J Med 2005; 352: 1305-1316.
45. Kasner SE, Chimowitz MI, Lynn MJ, et al.
Predictors of ischemic stroke in the territory
of a symptomatic intracranial arterial stenosis.
Circulation 2006; 113: 555-563.
46. Zaidat OO, Klucznik R, Alexander MJ, et al.
The NIH registry on use of the wingspan stent
for symptomatic 70-99% intracranial arterial
stenosis. Neurology 2008; 70: 1518-1524.
47. Derdeyn CP, Chimowitz MI, Lynn MJ, et al.
Aggressive medical treatment with or without
stenting in high-risk patients with intracranial
artery stenosis (SAMMPRIS): The final
results of a randomised trial. Lancet 2014;
383: 333-341.
48. Derdeyn CP, Chimowitz MI, Lynn MJ, et al.
Aggressive medical treatment with or without
stenting in high-risk patients with intracranial
artery stenosis (SAMMPRIS): The final
results of a randomised trial. Lancet 2014;
383: 333-341.
49. Liu L, Wong KS, Leng X, et al. Dual
antiplatelet therapy in stroke and ICAS:
Subgroup analysis of CHANCE. Neurology
2015; 85: 1154-1162.
50. Debette S, Leys D. Cervical-artery dissections:
Predisposing factors, diagnosis, and outcome.
Lancet Neurol 2009; 8: 668-678.
51. Kennedy F, Lanfranconi S, Hicks C, et al.
Antiplatelets vs anticoagulation for dissection:
CADISS nonrandomized arm and meta-
analysis. Neurology 2012; 79: 686-689.
52. Markus HS, Levi C, King A, Madigan J,
Norris J, Investigators of CADiSS. Antiplatelet
therapy vs anticoagulation therapy in cervical
artery dissection: The cervical artery dissection
in stroke study (CADISS) randomized clinical
trial final results. JAMA Neurol 2019; 76: 657-
 ߨЖӰ‫ܒ‬ીՖ‫ܒ‬သϛॳ‫ת‬Ֆω‫ݖ‬᛾‫ݽސ‬ᕛࡾЕ
664.
53. D i Tu l l i o M R , S a c c o R L , H o m m a S .
Atherosclerotic disease of the aortic arch as
a risk factor for recurrent ischemic stroke. N
Engl J Med 1996; 335: 1464.
54. Cohen A, Tzourio C, Bertrand B, Chauvel
C, Bousser MG, Amarenco P. Aortic plaque
morphology and vascular events: A follow-up
study in patients with ischemic stroke. FAPS
investigators. French study of Aortic Plaques
in Stroke. Circulation 1997; 96: 3838-3841.
55. Kronzon I, Tunick PA. Aortic atherosclerotic
disease and stroke. Circulation 2006; 114: 63-
75.
56. Amarenco P, Duyckaerts C, Tzourio C, Henin
D, Bousser MG, Hauw JJ. The prevalence of
ulcerated plaques in the aortic arch in patients
with stroke. N Engl J Med 1992; 326: 221-
225.
57. Yoshimura S, Toyoda K, Kuwashiro T, et al.
Ulcerated plaques in the aortic arch contribute
to symptomatic multiple brain infarction. J
Neurol Neurosurg Psychiatry 2010; 81: 1306-
1311.
58. Dressler FA, Craig WR, Castello R, Labovitz
AJ. Mobile aortic atheroma and systemic
emboli: Efficacy of anticoagulation and
influence of plaque morphology on recurrent
stroke. J Am Coll Cardiol 1998; 31: 134-138.
59. Ferrari E, Vidal R, Chevallier T, Baudouy
M. Atherosclerosis of the thoracic aorta and
aortic debris as a marker of poor prognosis:
Benefit of oral anticoagulants. J Am Coll
Cardiol 1999; 33: 1317-1322.
60. Nishiga M, Izumi C, Matsutani H, et al.
Effects of medical treatment on the prognosis
and risk of embolic events in patients with
severe aortic plaque. J Atheroscler Thromb
2013; 20: 821-829.
61. Tunick PA, Nayar AC, Goodkin GM, et al.
Effect of treatment on the incidence of stroke
and other emboli in 519 patients with severe
thoracic aortic plaque. Am J Cardiol 2002; 90:
1320-1325.
62. Amarenco P, Davis S, Jones EF, et al.
Clopidogrel plus aspirin versus warfarin in
patients with stroke and aortic arch plaques.
Stroke 2014; 45: 1248-1257.
63. Hart RG, Diener H-C, Coutts SB, et al.
Embolic strokes of undetermined source:
The case for a new clinical construct. Lancet
Neurol 2014; 13: 429-438.
64. Boeckh-Behrens T, Kleine JF, Zimmer
C, et al. Thrombus histology suggests
cardioembolic cause in cryptogenic stroke.
Stroke 2016; 47: 1864-1871.
65. Hart RG, Sharma M, Mundl H, et al.
Rivaroxaban for stroke prevention after
embolic stroke of undetermined source. N
Engl J Med 2018; 378: 2191-2201.
66. Diener H-C, Sacco RL, Easton JD, et al.
Dabigatran for prevention of stroke after
embolic stroke of undetermined source. N
Engl J Med 2019; 380: 1906-1917.
67. Durand-Zaleski I, Bertrand M. The value
of clopidogrel versus aspirin in reducing
atherothrombotic events: The CAPRIE study.
Pharmacoeconomics 2004; 22 Suppl 4: 19-
27.
68. Pezalla E, Day D, Pulliadath I. Initial
assessment of clinical impact of a drug
interaction between clopidogrel and proton
pump inhibitors. J Am Coll Cardiol 2008; 52:
1038-1039.
69. Gilard M, Arnaud B, Cornily JC, et al.
Influence of omeprazole on the antiplatelet
action of clopidogrel associated with aspirin:
T h e r an d o m i zed , d o u b l e- b l i n d O C L A
27
 ߨЖӰ‫ܒ‬ીՖ‫ܒ‬သϛॳ‫ת‬Ֆω‫ݖ‬᛾‫ݽސ‬ᕛࡾЕ
(Omeprazole Clopidogrel Aspirin) study. J
Am Coll Cardiol 2008; 51: 256-260.
70. Yano H, Tsukahara K, Morita S, et al.
Influence of omeprazole and famotidine on the
antiplatelet effects of clopidogrel in addition
to aspirin in patients with acute coronary
syndromes: A prospective, randomized,
multicenter study. Circ J 2012; 76: 2673-
2680.
71. Steinhubl SR, Berger PB, Mann JT, 3rd, et
al. Early and sustained dual oral antiplatelet
therapy following percutaneous coronary
intervention: A randomized controlled trial.
JAMA 2002; 288: 2411-2420.
72. Yusuf S, Zhao F, Mehta SR, et al. Effects of
clopidogrel in addition to aspirin in patients
with acute coronary syndromes without ST-
segment elevation. N Engl J Med 2001; 345:
494-502.
73. Lee M, Wu YL, Saver JL, et al. Is clopidogrel
better than aspirin following breakthrough
strokes while on aspirin? A retrospective
cohort study. BMJ open 2014; 4: e006672.
74. Kim JT, Park MS, Choi KH, et al. Different
antiplatelet strategies in patients with new
ischemic stroke while taking aspirin. Stroke
2016; 47: 128-134.
75. Bonello L, Tantry US, Marcucci R, et al.
Consensus and future directions on the
definition of high on-treatment platelet
reactivity to adenosine diphosphate. J Am
Coll Cardiol 2010; 56: 919-933.
76. Collet JP, Cuisset T, Range G, et al. Bedside
monitoring to adjust antiplatelet therapy for
coronary stenting. N Engl J Med 2012; 367:
2100-2109.
77. Depta JP, Fowler J, Novak E, et al. Clinical
outcomes using a platelet function-guided
approach for secondary prevention in patients
28
with ischemic stroke or transient ischemic
attack. Stroke 2012; 43: 2376-2381.
78. Kim BJ, Lee E-J, Kwon SU, et al. Prevention
of cardiovascular events in asian patients
with ischaemic stroke at high risk of cerebral
haemorrhage (PICASSO): A multicentre,
randomised controlled trial. Lancet Neurol
2018; 17: 509-518.
79. Collaboration R. Effects of antiplatelet
therapy after stroke due to intracerebral
haemorrhage (RESTART): A randomised,
open-label trial. Lancet 2019; 393: 2613-
2623.
80. Cast: Randomised placebo-controlled trial
of early aspirin use in 20,000 patients with
acute ischaemic stroke. CAST (Chinese Acute
Stroke Trial) collaborative group. Lancet
1997; 349: 1641-1649.
81. The international stroke trial (IST): A
randomised trial of aspirin, subcutaneous
heparin, both, or neither among 19435 patients
with acute ischaemic stroke. International
stroke trial collaborative group. Lancet 1997;
349: 1569-1581.
82. Rothwell PM, Algra A, Chen Z, Diener HC,
Norrving B, Mehta Z. Effects of aspirin on
risk and severity of early recurrent stroke
after transient ischaemic attack and ischaemic
stroke: Time-course analysis of randomised
trials. Lancet 2016; 388: 365-375.
83. National Institute of Neurological Disorders
and Stroke rt-PA Stroke Study Group. Tissue
plasminogen activator for acute ischemic
stroke. N Engl J Med 1995; 333: 1581-1587.
84. 僛⋺ᷕ⋣䗪⎹ᶲ䣦Ểᾅ昢⥼⒉Ể烉㖍㛔朁
㲐埨㞻㹞妋(rt-PA)䗪㱽炻怑㬋㱣䗪㊯憅炻
䫔ᶱ䇰ˤ
85. Powers WJ, Rabinstein AA, Ackerson T, et
al. Guidelines for the early management of
 ߨЖӰ‫ܒ‬ીՖ‫ܒ‬သϛॳ‫ת‬Ֆω‫ݖ‬᛾‫ݽސ‬ᕛࡾЕ
patients with acute ischemic stroke: 2019
update to the 2018 guidelines for the early
management of acute ischemic stroke: A
guideline for healthcare professionals from
the American Heart Association/American
Stroke Association. Stroke 2019; 50: e344-
e418.
86. Jeong HG, Kim BJ, Yang MH, Han MK,
Bae HJ, Lee SH. Stroke outcomes with use
of antithrombotics within 24 hours after
recanalization treatment. Neurology 2016; 87:
996-1002.
87. Suri MF, Hussein HM, Abdelmoula MM,
Divani AA, Qureshi AI. Safety and tolerability
of 600 mg clopidogrel bolus in patients
with acute ischemic stroke: Preliminary
experience. Med Sci Monit 2008; 14: PI39-44.
88. Lee YS, Bae HJ, Kang DW, et al. Cilostazol
in acute ischemic stroke treatment (CAIST
trial): A randomized double-blind non-
inferiority trial. Cerebrovasc Dis 2011; 32:
65-71.
89. Shimizu H, Tominaga T, Ogawa A, et
al. Cilostazol for the prevention of acute
progressing stroke: A multicenter, randomized
controlled trial. J Stroke Cerebrovasc Dis
2013; 22: 449-456.
90. Dengler R, Diener HC, Schwartz A, et al.
Early treatment with aspirin plus extended-
release dipyridamole for transient ischaemic
attack or ischaemic stroke within 24 h of
symptom onset (EARLY trial): A randomised,
open-label, blinded-endpoint trial. Lancet
Neurol 2010; 9: 159-166.
91. Kennedy J, Hill MD, Ryckborst KJ, et al. Fast
assessment of stroke and transient ischaemic
attack to prevent early recurrence (FASTER):
A randomised controlled pilot trial. Lancet
Neurol 2007; 6: 961-969.
92. Wang Y, Zhao X, Liu L, et al. Clopidogrel
with aspirin in acute minor stroke or transient
ischemic attack. N Engl J Med 2013; 369: 11-
19.
93. Wong KS, Chen C, Fu J, et al. Clopidogrel
plus aspirin versus aspirin alone for
reducing embolisation in patients with
acute symptomatic cerebral or carotid artery
stenosis (CLAIR study): A randomised, open-
label, blinded-endpoint trial. Lancet Neurol
2010; 9: 489-497.
94. Johnston SC, Easton JD, Farrant M, et al.
Clopidogrel and aspirin in acute ischemic
stroke and high-risk tia. N Engl J Med 2018;
379: 215-225.
95. J i n g J , M e n g X , Z h a o X , e t a l . D u a l
antiplatelet therapy in transient ischemic
attack and minor stroke with different
infarction patterns: Subgroup analysis of
the chance randomized clinical trial. JAMA
Neurol 2018; 75: 711-719.
96. Pan Y, Jing J, Chen W, et al. Risks and
benefits of clopidogrel-aspirin in minor stroke
or TIA: Time course analysis of CHANCE.
Neurology 2017; 88: 1906-1911.
97. Hao Q, Tampi M, O'Donnell M, Foroutan
F, Siemieniuk RA, Guyatt G. Clopidogrel
plus aspirin versus aspirin alone for acute
minor ischaemic stroke or high risk transient
ischaemic attack: Systematic review and
meta-analysis. BMJ 2018; 363: k5108.
98. Pan Y, Elm JJ, Li H, et al. Outcomes
associated with clopidogrel-aspirin use in
minor stroke or transient ischemic attack:
A pooled analysis of clopidogrel in high-
risk patients with acute non-disabling
cerebrovascular events (CHANCE) and
platelet-oriented inhibition in new TIA
and minor ischemic stroke (POINT) trials.
29
 ߨЖӰ‫ܒ‬ીՖ‫ܒ‬သϛॳ‫ת‬Ֆω‫ݖ‬᛾‫ݽސ‬ᕛࡾЕ
JAMA Neurol 2019 Aug 19. doi: 10.1001/
jamaneurol.2019.2531.
99. P a n Y, C h e n W, X u Y, e t a l . G e n e t i c
polymorphisms and clopidogrel efficacy for
acute ischemic stroke or transient ischemic
attack: A systematic review and meta-analysis.
Circulation 2017; 135: 21-33.
100. Wang Y, Zhao X, Lin J, et al. Association
between cyp2c19 loss-of-function allele status
and efficacy of clopidogrel for risk reduction
among patients with minor stroke or transient
ischemic attack. JAMA 2016; 316: 70-78.
101. Bath PM, Woodhouse LJ, Appleton JP, et al.
Antiplatelet therapy with aspirin, clopidogrel,
and dipyridamole versus clopidogrel alone
or aspirin and dipyridamole in patients
with acute cerebral ischaemia (TARDIS): A
randomised, open-label, phase 3 superiority
trial. Lancet 2018; 391: 850-859.
102. Johnston SC, Amarenco P, Albers GW, et al.
Ticagrelor versus aspirin in acute stroke or
transient ischemic attack. N Engl J Med 2016;
375: 35-43.
103. Amarenco P, Albers GW, Denison H, et al.
Efficacy and safety of ticagrelor versus aspirin
in acute stroke or transient ischaemic attack
of atherosclerotic origin: A subgroup analysis
of SOCRATES, a randomised, double-blind,
controlled trial. Lancet Neurol 2017; 16: 301-
310.
104. Wang Y, Minematsu K, Wong KS, et al.
Ticagrelor in acute stroke or transient
ischemic attack in asian patients: From the
SOCRATES trial (acute stroke or transient
ischemic attack treated with aspirin or
ticagrelor and patient outcomes). Stroke 2017;
48: 167-173.
105. Wong KSL, Amarenco P, Albers GW, et al.
Efficacy and safety of ticagrelor in relation
30
to aspirin use within the week before
randomization in the SOCRATES trial. Stroke
2018; 49: 1678-1685.
106. Johnston SC, Amarenco P, Denison H, et
al. The acute stroke or transient ischemic
attack treated with ticagrelor and aspirin for
prevention of stroke and death (THALES)
trial: Rationale and design. Int J Stroke 2019;
14: 745-751.
107. Aoki J, Iguchi Y, Urabe T, et al. Acute
aspirin plus cilostazol dual therapy for
noncardioembolic stroke patients within 48
hours of symptom onset. J Am Heart Assoc
2019; 8: e012652.
108. Adams HP, Jr., Leira EC, Torner JC, et al.
Treating patients with 'wake-up' stroke: The
experience of the abestt-ii trial. Stroke 2008;
39: 3277-3282.
109. Zinkstok SM, Roos YB, investigators A. Early
administration of aspirin in patients treated
with alteplase for acute ischaemic stroke: A
randomised controlled trial. Lancet 2012; 380:
731-737.
110. Siebler M, Hennerici MG, Schneider D, et al.
Safety of tirofiban in acute ischemic stroke:
The SATIS trial. Stroke 2011; 42: 2388-2392.
111. Delgado F, Oteros R, Jimenez-Gomez E,
Bravo Rey I, Bautista MD, Valverde Moyano
R. Half bolus dose of intravenous abciximab
is safe and effective in the setting of acute
stroke endovascular treatment. J Neurointerv
Surg 2019; 11: 147-152.
112. Ernst M, Butscheid F, Fiehler J, et al.
Glycoprotein iib/iiia inhibitor bridging
and subsequent endovascular therapy in
vertebrobasilar occlusion in 120 patients. Clin
Neuroradiol 2016; 26: 169-175.
113. Sun C, Li X, Zhao Z, et al. Safety and efficacy
of tirofiban combined with mechanical
 ߨЖӰ‫ܒ‬ીՖ‫ܒ‬သϛॳ‫ת‬Ֆω‫ݖ‬᛾‫ݽސ‬ᕛࡾЕ
thrombectomy depend on ischemic stroke
etiology. Front Neurol 2019; 10: 1100.
114. Robinson JG, Rahilly-Tierney C, Lawler
E, Gaziano JM. Benefits associated with
achieving optimal risk factor levels for the
primary prevention of cardiovascular disease
in older men. J Clin Lipidol 2012; 6: 58-65.
115. Final report on the aspirin component of the
ongoing Physicians’ Health Study. Steering
committee of the Physicians’ Health Study
research group. N Engl J Med 1989; 321: 129-
135.
116. Hart RG, Halperin JL, McBride R, Benavente
O, Man-Son-Hing M, Kronmal RA. Aspirin
for the primary prevention of stroke and other
major vascular events: Meta-analysis and
hypotheses. Arch Neurol 2000; 57: 326-332.
117. Antithrombotic Trialists C, Baigent C,
Blackwell L, et al. Aspirin in the primary and
secondary prevention of vascular disease:
Collaborative meta-analysis of individual
participant data from randomised trials.
Lancet 2009; 373: 1849-1860.
118. R a j u N , S o b i e r a j - Te a g u e M , H i r s h J ,
O’Donnell M, Eikelboom J. Effect of aspirin
on mortality in the primary prevention of
cardiovascular disease. Am J Med 2011; 124:
621-629.
119. Ridker PM, Cook NR, Lee IM, et al. A
randomized trial of low-dose aspirin in the
primary prevention of cardiovascular disease
in women. N Engl J Med 2005; 352: 1293-
1304.
120. Force USPST. Aspirin for the prevention
of cardiovascular disease: U.S. Preventive
services task force recommendation statement.
Ann Intern Med 2009; 150: 396-404.
121. Meschia JF, Bushnell C, Boden-Albala B,
et al. Guidelines for the primary prevention
of stroke: A statement for healthcare
professionals from the American Heart
Association/American Stroke Association.
Stroke 2014; 45: 3754-3832.
122. Bushnell C, McCullough LD, Awad IA, et
al. Guidelines for the prevention of stroke
in women: A statement for healthcare
professionals from the American Heart
Association/American Stroke Association.
Stroke 2014; 45: 1545-1588.
123. Ogawa H, Nakayama M, Morimoto T, et al.
Low-dose aspirin for primary prevention of
atherosclerotic events in patients with type 2
diabetes: A randomized controlled trial. JAMA
2008; 300: 2134-2141.
124. Butalia S, Leung AA, Ghali WA, Rabi DM.
Aspirin effect on the incidence of major
adverse cardiovascular events in patients with
diabetes mellitus: A systematic review and
meta-analysis. Cardiovasc Diabetol 2011; 10:
25.
125. Carandang R, Seshadri S, Beiser A, et al.
Trends in incidence, lifetime risk, severity,
and 30-day mortality of stroke over the past
50 years. JAMA 2006; 296: 2939-2946.
126. Kubo M, Hata J, Doi Y, Tanizaki Y, Iida M,
Kiyohara Y. Secular trends in the incidence
of and risk factors for ischemic stroke and its
subtypes in japanese population. Circulation
2008; 118: 2672-2678.
127. Yu NC, Su HY, Chiou ST, et al. Trends of
abc control 2006-2011: A national survey of
diabetes health promotion institutes in taiwan.
Diabetes Res Clin Pract 2013; 99: 112-119.
128. Lee M, Wu YL, Ovbiagele B. Trends in
incident and recurrent rates of first-ever
ischemic stroke in Taiwan between 2000 and
2011. J Stroke 2016; 18: 60-65.
129. McNeil JJ, Nelson MR, Woods RL, et al.
31
 ߨЖӰ‫ܒ‬ીՖ‫ܒ‬သϛॳ‫ת‬Ֆω‫ݖ‬᛾‫ݽސ‬ᕛࡾЕ
Effect of aspirin on all-cause mortality in the
healthy elderly. N Engl J Med 2018; 379:
1519-1528.
130. Group ASC, Bowman L, Mafham M, et al.
Effects of aspirin for primary prevention in
persons with diabetes mellitus. N Engl J Med
2018; 379: 1529-1539.
131. Gaziano JM, Brotons C, Coppolecchia R,
et al. Use of aspirin to reduce risk of initial
vascular events in patients at moderate risk
of cardiovascular disease (ARRIVE): A
randomised, double-blind, placebo-controlled
trial. Lancet 2018; 392: 1036-1046.
132. Peto R, Gray R, Collins R, et al. Randomised
trial of prophylactic daily aspirin in british
male doctors. BMJ 1988; 296: 313-316.
133. Steering Committee of the Physicians' Health
Study Research G. Final report on the aspirin
component of the ongoing Physicians’ Health
Study. N Engl J Med 1989; 321: 129-135.
134. Thrombosis prevention trial: Randomised
trial of low-intensity oral anticoagulation with
warfarin and low-dose aspirin in the primary
prevention of ischaemic heart disease in
men at increased risk. The medical research
council's general practice research framework.
Lancet 1998; 351: 233-241.
135. Hansson L, Zanchetti A, Carruthers SG,
et al. Effects of intensive blood-pressure
lowering and low-dose aspirin in patients
with hypertension: Principal results of the
hypertension optimal treatment (HOT)
randomised trial. Hot study group. Lancet
1998; 351: 1755-1762.
136. de Gaetano G, Collaborative Group of the
Primary Prevention P. Low-dose aspirin
and vitamin E in people at cardiovascular
risk: A randomised trial in general practice.
Collaborative group of the primary prevention
32
project. Lancet 2001; 357: 89-95.
137. Ridker PM, Cook NR, Lee IM, et al. A
randomized trial of low-dose aspirin in the
primary prevention of cardiovascular disease
in women. N Engl J Med 2005; 352: 1293-
1304.
138. Belch J, MacCuish A, Campbell I, et al. The
prevention of progression of arterial disease
and diabetes (POPADAD) trial: Factorial
randomised placebo controlled trial of aspirin
and antioxidants in patients with diabetes and
asymptomatic peripheral arterial disease. BMJ
2008; 337: a1840.
139. Ogawa H, Nakayama M, Morimoto T, et al.
Low-dose aspirin for primary prevention of
atherosclerotic events in patients with type 2
diabetes: A randomized controlled trial. JAMA
2008; 300: 2134-2141.
140. Fowkes FGR, Price JF, Stewart MCW, et
al. Aspirin for prevention of cardiovascular
events in a general population screened for
a low ankle brachial index: A randomized
controlled trial. JAMA 2010; 303: 841-848.
141. Ikeda Y, Shimada K, Teramoto T, et al.
Low-dose aspirin for primary prevention of
cardiovascular events in japanese patients 60
years or older with atherosclerotic risk factors:
A randomized clinical trial. JAMA 2014; 312:
2510-2520.
142. Effects of aspirin for primary prevention in
persons with diabetes mellitus. N Engl J Med
2018; 379: 1529-1539.
143. Gaziano JM, Brotons C, Coppolecchia R,
et al. Use of aspirin to reduce risk of initial
vascular events in patients at moderate risk
of cardiovascular disease (ARRIVE): A
randomised, double-blind, placebo-controlled
trial. Lancet 2018; 392: 1036-1046.
144. McNeil JJ, Nelson MR, Woods RL, et al.
 ߨЖӰ‫ܒ‬ીՖ‫ܒ‬သϛॳ‫ת‬Ֆω‫ݖ‬᛾‫ݽސ‬ᕛࡾЕ
Effect of aspirin on all-cause mortality in the
healthy elderly. N Engl J Med 2018; 379:
1519-1528.
145. Zheng SL, Roddick AJ. Association of
aspirin use for primary prevention with
cardiovascular events and bleeding events: A
systematic review and meta-analysis. JAMA
2019; 321: 277-287.
146. Huang WY, Saver JL, Wu YL, Lin CJ, Lee
M, Ovbiagele B. Frequency of intracranial
hemorrhage with low-dose aspirin in individuals
without symptomatic cardiovascular disease:
A systematic review and meta-analysis.
JAMA Neurol 2019 May 13. doi: 10.1001/
jamaneurol.2019.1120.
147. B e rg e r J S , K r a n t z M J , K i t t e l s o n J M ,
Hiatt WR. Aspirin for the prevention of
cardiovascular events in patients with
peripheral artery disease: A meta-analysis of
randomized trials. JAMA 2009; 301: 1909-
1919.
148. Fowkes FG, Price JF, Stewart MC, et al.
Aspirin for prevention of cardiovascular
events in a general population screened for
a low ankle brachial index: A randomized
controlled trial. JAMA 2010; 303: 841-848.
149. Belch J, MacCuish A, Campbell I, et al. The
prevention of progression of arterial disease
and diabetes (POPADAD) trial: Factorial
randomised placebo controlled trial of aspirin
and antioxidants in patients with diabetes and
asymptomatic peripheral arterial disease. BMJ
2008; 337: a1840.
150. Uchiyama S, Demaerschalk BM, Goto S, et
al. Stroke prevention by cilostazol in patients
with atherothrombosis: Meta-analysis of
placebo-controlled randomized trials. J Stroke
Cerebrovasc Dis 2009; 18: 482-490.
151. Nadareishvili ZG, Rothwell PM, Beletsky V,
Pagniello A, Norris JW. Long-term risk of
stroke and other vascular events in patients
with asymptomatic carotid artery stenosis.
Arch Neurol 2002; 59: 1162-1166.
152. Abbott AL, Chambers BR, Stork JL, Levi CR,
Bladin CF, Donnan GA. Embolic signals and
prediction of ipsilateral stroke or transient
ischemic attack in asymptomatic carotid
stenosis: A multicenter prospective cohort
study. Stroke 2005; 36: 1128-1133.
153. Abbott AL. Medical (nonsurgical) intervention
alone is now best for prevention of stroke
associated with asymptomatic severe carotid
stenosis: Results of a systematic review and
analysis. Stroke 2009; 40: e573-583.
154. Marquardt L, Geraghty OC, Mehta Z,
Rothwell PM. Low risk of ipsilateral stroke in
patients with asymptomatic carotid stenosis
on best medical treatment: A prospective,
population-based study. Stroke 2010; 41: e11-
17.
155. King A, Shipley M, Markus H, Investigators
A. The effect of medical treatments on stroke
risk in asymptomatic carotid stenosis. Stroke
2013; 44: 542-546.
156. Murphy SJX, Naylor AR, Ricco JB, et al.
Optimal antiplatelet therapy in moderate to
severe asymptomatic and symptomatic carotid
stenosis: A comprehensive review of the
literature. Eur J Vasc Endovasc Surg 2019;
57: 199-211.
157. Ridker PM. Should aspirin be used for
primary prevention in the post-statin era? N
Engl J Med 2018; 379: 1572-1574.
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2020 Taiwan Stroke Society Guideline on Antiplatelet

Therapy for Noncardioembolic Ischemic Stroke
Po-Lin Chen1, Chih-Hao Chen2, Sung-Chun Tang2, Li-Ming Lien3, Ku-Chou Chang4,
Jiunn-Tay Lee5, Chung-Hsiang Liu6, Yu-Wei Chen7, Lung Chan8, Ya-Ju Lin9,
Pi-Shan Sung10, Sheng-Yang Hsieh11, Chih-Ping Chung12, Jiann-Shing Jeng2,
Taiwan Stroke Society Guideline Consensus Group
1
Stroke Center, Department of Neurology, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan.
2
Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan.
3
Department of Neurology, Shin Kong WHS Memorial Hospital, Taipei, Taiwan.
4
Division of Cerebrovascular Diseases, Department of Neurology, Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
5
Department of Neurology, Tri-Service General Hospital, Taipei, Taiwan.
6
Department of Neurology, China Medical University Hospital, Taichung, Taiwan.
7
Department of Neurology, Landseed International Hospital, Taoyuan, Taiwan.
8
Department of Neurology, Taipei Medical University Shuang-Ho Hospital, New Taipei City, Taiwan.
9
Department of Neurology, MacKay Memorial Hospital, Taipei, Taiwan.
10
Department of Neurology, National Cheng Kung University Hospital, Tainan, Taiwan.
11
Department of Neurology, Tainan Sin Lau Hospital, Tainan, Taiwan.
12
Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.

ABSTRACT
In the past 7 years, several important antiplatelet trials have been completed with pivotal findings.
These results were significant and have been already changing the daily practice of treatment for ischemic
stroke (IS). One of the most important findings is the concept of dual antiplatelet therapy for acute
noncardioembolic IS or transient ischemic attack. The timing and duration of antiplatelet therapy also
have significant impact on the outcomes of IS. In addition to traditional antiplatelets, such as aspirin or
clopidogrel, other antiplatelets, including cilostazol, ticagrelor, and prasugrel have also been investigated
for the efficacy and safety in the treatment for IS. Another important issue is the use of antiplatelet therapy
in primary prevention of cerebro- and cardio-vascular events, the results of several large clinical trials have
shown the antiplatelet therapy in specific populations with various estimated risks.
The purpose of this current guideline is to update the 2016 Taiwan Stroke Society (TSS) Guideline on
Antiplatelet Therapy for Noncardioembolic Ischemic Stroke particularly in areas for which new evidence
has emerged since its publication. The TSS Guideline Consensus Group revised the guideline based on the
data of several studies which are important and influential. This guideline focuses on three major topics,
including secondary prevention, acute management, and primary prevention for noncardioembolic ischemic
stroke. Recommendations and reviews of the evidences are provided.

Keywords: acute stroke, antiplatelet, ischemic stroke, noncardioembolic, prevention

Corresponding author: Po-Lin Chen, MD, Stroke Center, Department of Neurology, Neurological Institute, Taichung Veterans
General Hospital, Taichung, Taiwan
E-mail: boringtw@gmail.com

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