20xx年醫(yī)學專題—缺血性卒中tia患者的早期抗栓治0319(編輯修改稿)
2024-11-14 06:48 本頁面
【文章內容簡介】 tients who suffer a TIA or ischemic stroke of noncardiac origin should be treated with an antiplatelet agent (Class I, Level A). Initial therapy should be ASA 75162 mg once daily, clopidogrel 75 mg once daily, or ERdipyridamole 200 mg twice daily plus ASA 25 mg twice daily (Class I, Level A). The choice of antiplatelet therapy regimen is determined by consideration of cost, tolerance, and other associated vascular conditions. Available data does not allow for differentiation of antiplatelet regimen by specific stroke subtype (Class IIb, Level C). The combination of ASA 75162 mg daily plus clopidogrel 75 mg daily in the first month after TIA or minor ischemic stroke may be superior to aspirin alone in patients not at a high risk of bleeding (Class IIb, Level C). The combination of ASA 75162 mg daily plus clopidogrel 75 mg daily should not be used for secondary stroke prevention beyond 1 month unless otherwise indicated and the risk of bleeding is low (Class III, Level B).,? 2010加拿大最新指南將雙聯(lián)抗血小板治療(zh236。li225。o)列入推薦意見,Antiplatelet Therapy for the Secondary Prevention of Cerebrovascular Disease Working Group: Ashfaq Shuaib, MD, FRCP and Philip Teal, MD, FRCP,http://www.ccsguidelineprograms.ca/index.php,第二十三頁，共五十二頁。,氯吡格雷+ASA聯(lián)用 早期短期聯(lián)用，可能(kěn233。ng)有前途,,,氯吡格雷+ASA VS ASA,氯吡格雷+ASA VS 氯吡格雷,,氯吡格雷+ASA VS ASA,氯吡格雷+ASA VS ASA,療程(li225。och233。ng)28個月,療程(li225。och233。ng)18個月,療程90天,療程7天,FASTER/EXPRESS,氯吡格雷+ASA VS ASA,療程21天,FASTER2,但是：必須強調的是低危出血風險病人！特別是小卒中/TIA這樣早期高復發(fā)風險者！,第二十四頁，共五十二頁。,卒中/TIA長期(ch225。ngqī)二級預防的抗血小板治療推薦,第二十五頁，共五十二頁。,1. Ringleb PA et al. Stroke 2004。 35: 528–532.,*MI, 缺血性腦卒中或血管性死亡(sǐw225。ng)。 治療時間平均持續(xù) 1.6 年,,5.8%,10.2%,5.3%,8.8%,0,2,4,6,8,10,所有(suǒyǒu) CAPRIE 患者 (n=19,099),嚴重(y225。nzh242。ng)急性事件既往史 （MI或缺血性卒中） (n=4496),事件率／年* (%),ASA,氯吡格雷,12,p=0.043,RRR 8.7%,RRR 14.9%,p=0.045,CAPRIE:氯吡格雷對有血管事件高危患者的療效進一步加強,第二十六頁，共五十二頁。,1. Bhatt DL et al. Am J Cardiol 2002。 90: 625?628.,*MI, stroke, vascular death or rehospitalization for ischemic events/bleeding
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