颅内动脉粥样硬化相关RCT试验分析.pptVIP

颅内动脉粥样硬化狭窄治疗相关RCT试验 三个提前终止的RCT试验 WASID the Warfarin–Aspirin Symptomatic Intracranial Disease SAMMPRIS Stenting and Aggressive Medical Management for Preventing Recurrent stroke in IntracranialStenosis ESASIS the Early Stent-assisted Angioplasty in Symptomatic Intracranial Stenosis RCT- NO.1 N Engl J Med, 2005; 352 13 :1305-1316. Comparison of Warfarin and Aspirinfor Symptomatic Intracranial Arterial Stenosis Background Atherosclerotic intracranial arterial stenosis is an important cause of stroke. Warfarin is commonly used in preference to aspirin for this disorder, but these therapies have not been compared in a randomized trial. RCT- NO.1 The Warfarin-Aspirin Symptornatic Intracranial Disease Study NEUROLOGY 1995;45:1488-1493. 151 Patients with 50 to 99% stenosis of an intracranial artery were identified by reviewing the results of consecutive angiograms performed at participating centers between 1985 and 1991. Figure. Graph shows Kaplan-Meier estimates of proportion of patients remaining free of ischemic stroke, myocardial infarction, or sudden death in those treated with warfarin upper curve or aspirin lower curve . The relative risk of a major vascular event in those treated with warfarin was 0.46 95% CI, 0.23 to 0.86 compared with patients treated with aspirin. Methods We randomly assigned patients with transient ischemic attack or stroke caused by angiographically verified 50 to 99 percent stenosis of a major intracranial artery to receive warfarin target international normalized ratio, 2.0 to 3.0 or aspirin 1300 mg per day in a double-blind, multicenter clinical trial. The primary end point was ischemic stroke, brain hemorrhage, or death from vascular causes other than stroke. RCT- NO.1 After 569 patients had undergone randomization, enrollment was stopped because of concerns about the safety of the patients who had been assigned to receive warfarin. Results RCT- NO.1 Conclusions Warfarin was associated with significantly higher rates of adve