抗血小板药和抗凝药的临床合理应用介绍.ppt

* As a result of these analyses, the authors were able to add to current knowledge of antiplatelet therapy. They were able to conclude that where patients have a contraindication to ASA, the ADP-receptor antagonist clopidogrel is an appropriate alternative, and that in certain clinical circumstances, the addition of a second antiplatelet drug to ASA may produce additional benefits. They do, however, note that more research into this strategy is needed.1,2 It is important to note that the CURE trial publication was outside the time window of this meta-analysis, and we now know that clopidogrel plus ASA produces a 20% relative risk reduction in ischemic events* with long-term? use.3 *Cardiovascular death, MI and stroke ?Up to 12 months References:1. Antithrombotic Trialists’ Collaboration. BMJ 2002; 324: 71–86. 2. Antiplatelet Trialists’ Collaboration. BMJ 1994; 308: 81–106. 3. The CURE Trial Investigators. N Engl J Med 2001; 345: 494–502 * * * Acute PE is associated with a high risk of mortality; approximately one in every six patients dies within 3 months of acute PE, with 75% of deaths occurring during the initial hospital admission for acute PE. The graph in the slide shows the mortality rates excluding patients in whom PE was first recognised at necropsy, and so is somewhat lower than for the overall death toll. PE also has serious long-term implications for patients who survive acute PE; recurrence is common, and recurrent PE is associated with a greatly increased risk of mortality (~3-fold increased mortality compared to the initial episode). A large proportion of patients (17%) have to be readmitted to hospital within 3 months of the initial episode. Patients with PE require prolonged care that can make heavy demands on healthcare resources. Goldhaber SZ, et al. Lancet 1999; 353:1386–1389. Serious implications for health and survival PE: the burden of mortality Slide A26 * * * * * * * * * * * * * * The normal coagulation process is a delica