培训课件-抗血小板药物的临床选择.ppt

* * MATCH研究 The Management of Atherothrombosis with Clopidogrel in High-Risk Patients with Recent Transient Ischemic Attack TIA or Ischemic Stroke， * 纳入标准： 男女不限， 18岁 彩超证实的颈动脉狭窄（非手术治疗） 50% 峰值流速 120 cm/sec 近3个月狭窄同侧TIA缺血性卒中 卒中由CT证实，TIA 30分钟和一过性黑朦 在TCD测定同侧MCA1小时至少发现1个典型MES * 除ACS和PCI患者外，单一阿司匹林仍然是各国冠心病指南推荐的长期基本用药。CHARISMA研究证实：对于稳定性患者和一级预防人群而言，在阿司匹林基础上加用氯吡格雷不但疗效未增加，而且出血副作用明显增加。 Background Dual antiplatelet therapy with clopidogrel plus low-dose aspirin has not been studied in a broad population of patients at high risk for atherothrombotic events. Methods We randomly assigned 15,603 patients with either clinically evident cardiovascular disease or multiple risk factors to receive clopidogrel 75 mg per day plus low-dose aspirin 75 to 162 mg per day or placebo plus low-dose aspirin and followed them for a median of 28 months. The primary efficacy end point was a composite of myocardial infarction, stroke, or death from cardiovascular causes. Results The rate of the primary efficacy end point was 6.8 percent with clopidogrel plus aspirin and 7.3 percent with placebo plus aspirin relative risk, 0.93; 95 percent confidence interval, 0.83 to 1.05; P 0.22 . The respective rate of the principal secondary efficacy end point, which included hospitalizations for ischemic events, was 16.7 percent and 17.9 percent relative risk, 0.92; 95 percent confidence interval, 0.86 to 0.995; P 0.04 , and the rate of severe bleeding was 1.7 percent and 1.3 percent relative risk, 1.25; 95 percent confidence interval, 0.97 tο 1.61 percent; P 0.09 . The rate of the primary end point among patients with multiple risk factors was 6.6 percent with clopidogrel and 5.5 percent with placebo relative risk, 1.2; 95 percent confidence interval, 0.91 to 1.59; P 0.20 and the rate of death from cardiovascular causes also was higher with clopidogrel 3.9 percent vs. 2.2 percent, P 0.01 . In the subgroup with clinically evident atherothrombosis, the rate was 6.9 percent with clopidogr