缺血性卒中／TIA二级预防中抗血小板药物规范化应用的中国专家共识.pptVIP

缺血性卒中／TIA二级预防中抗血小板药物规范化应用的中国专家共识 抗血小板药物证据 抗血小板药物证据 抗血小板药物证据 抗血小板药物证据 《缺血性卒中/TIA二级预防中抗血小板药物规范化应用的中国专家共识》 建议一： 非心源性栓塞的缺血性卒中/TIA患者（脑动脉粥样硬化性、腔隙性和病因不明性），为减少卒中复发或其他血管事件的风险，建议使用抗血小板药物，而不能用其他任何药物替代（I类推荐，A级证据） 缺血性卒中/TIA后应尽早启动抗血小板治疗（I 类推荐，A级证据） 如果没有禁忌症，应该长期使用抗血小板药物（I类推荐，A级证据） 《缺血性卒中/TIA二级预防中抗血小板药物规范化应用的中国专家共识》 建议二： 氯吡格雷(75mg/日) 、阿司匹林(50～325mg/日)、缓释双嘧达莫(200mg)与阿司匹林（25mg）复方制剂（2次/日）都可作为首选的抗血小板药物（I类推荐，A级证据）。 依据各种抗血小板治疗药物的获益、相应风险及费用进行个体化治疗（II类推荐，C级证据）。 脑动脉粥样硬化性卒中以及既往有脑梗死病史、冠心病、糖尿病或周围血管病者优先考虑氯吡格雷(75mg/日)（I类推荐，B级证据）。 高危非急性缺血性卒中患者不建议氯吡格雷和阿司匹林长期联用，除非患者合并有不稳定型心绞痛、无Q波心肌梗死或冠状动脉支架置入术者，治疗方案为可给予氯吡格雷和阿司匹林联用(氯吡格雷300mg负荷剂量，此后75mg/日)+阿司匹林(75-150mg/日)，治疗应持续到事件发生后9-12个月（I类推荐，A级证据） 近期脑动脉支架置入术者，氯吡格雷联合阿司匹林，(氯吡格雷300mg负荷剂量，此后75mg/日)+阿司匹林(75-150mg/日)，治疗30天(I类推荐，C级证据)，然后改为单用氯吡格雷9-12个月，重新评估风险后再决定下一步抗血小板药物的选择(II类推荐，C级证据)。 June 2006 * June 2006 * As clopidogrel was superior to ASA in atherothrombotic disease patients in the CAPRIE study, and its benefit appeared to be greater in some high-risk subgroups, the MATCH trial was conducted to assess whether adding ASA to clopidogrel could have a greater benefit than clopidogrel alone in preventing vascular events with potentially higher bleeding risk. MATCH was a randomized, double-blind, placebo-controlled trial. Patients already receiving clopidogrel 75 mg/day were given ASA (75 mg/day) or placebo in 7599 high-risk patients with recent ischemic stroke or transient ischemic attack and at least one additional vascular risk factor. Patients were treated and followed for 18 months, and the primary endpoint was a composite of ischemic stroke, myocardial infarction, cardiovascular death, or rehospitalization for acute ischemia (including rehospitalization for transient ischemic attack, angina pectoris, or worsening of peripheral arterial disease). In the intention to treat analysis, 596 (15.7%) patients reached the primary endpoint in the group receiving ASA and clopidogrel compared with 636 (16.7%) in the clopidogrel alone group (relative risk reduction 6.4%, [95