培训课件-抗血小板治疗平衡之道.ppt

替格瑞洛价值与探讨 研究中平均用药时间仅277天，缺乏长期维持治疗的证据 Non-CABG出血风险明显升高 卒中获益不优于氯吡格雷，致死性颅内出血发生率明显升高，用于缺血性卒中患者是否获益尚待斟酌； 存在呼吸困难等显著不良反应，且因给药次数较多降低治疗依从性。对于快速逆转的药物来说，直接停药对再发MI和卒中可能具有潜在的影响； PLATO排除溶栓治疗和口服抗凝治疗的患者，这些ACS患者联用替格瑞洛的疗效/安全性尚不明。 探讨 显著降低全因死亡和急性MI，而不增加严重出血的发生率 适用于CABG患者，PLATO研究中CABG术前24-48小时停用并不增加出血风险 降低复合终点发生危险达16%，如得到进一步研究证实，为平衡其不良反应所致风险留出了较多的空间 价值 2010年 7月 27日 04:34 However, subgroup analysis found that ticagrelor apparently had no benefit for the studys 1,814 U.S. participants, and American patients taking ticagrelor actually had a 27% greater risk of having a clinical event than those taking clopidogrel (with a 95% confidence interval, ranging from 0.92 to 1.75). AstraZeneca has said that the difference in efficacy is because U.S. patients were taking higher doses of aspirin. Ticagrelors label states that it should be administered with low dose (75 to 100 mg) of aspirin. Play of chance, could be a possible explanation, they wrote, although that may be overstretching considering the U.S. population had a 27% greater risk for adverse events on ticagrelor while the rest of the world shows a clear benefit from it. Marciniak said that while efficacy is a bigger issue than safety for ticagrelor, there were a number of safety concerns. The most important safety issue for ticagrelor was bleeding, wrote another FDA reviewer. Major bleeds and less serious bleeds were substantially increased with ticagrelor. Some 14.5% of patients in the ticagrelor group experienced bleeding compared to 13.2% in the clopidogrel group (P=0.0083). However, life-threatening and fatal bleeds were not significantly increased in the ticagrelor group. The FDAs clinical safety reviewer commented that most major bleeds were CABG-related. The risk of CABG-bleeding was increased in ticagrelor patients who underwent CABG fewer than five days after stopping ticagrelor. Delaying major surgery for five or more after stopping ticagrelor is the most important management principle for dealing with the increased bleed