缺血性卒中二级预防规范-1.ppt

2013 ACC/AHA 胆固醇治疗指南对他汀治疗强度的推荐 高强度他汀治疗 中等强度他汀治疗 低强度他汀治疗 LDL-C降幅≥50% 日剂量 LDL-C降低30-50%/ 日剂量 LDL-C降幅30% 日剂量 阿托伐他汀 40-80mg 瑞舒伐他汀20-40*mg 阿托伐他汀10（20）mg 瑞舒伐他汀（5）10mg 辛伐他汀20-40mg 普伐他汀40（80）mg 洛伐他汀40mg 氟伐他汀 XL 80mg 氟伐他汀 40mg bid 匹伐他汀2-4mg 辛伐他汀10mg 普伐他汀10-20mg 洛伐他汀20mg 氟伐他汀20-40mg 匹伐他汀1mg * 瑞舒伐他汀40mg剂量在中国未获批准 Stone NJ, et al. JACC. 2013, doi:10.1016/j.jacc.2013.11.002. 基于病因和发病机制的干预 病因和发病机制 抗栓治疗 他汀 降压 其他 大动脉粥样硬化血栓形成性 载血动脉斑块堵塞穿支 氯吡格雷／阿司匹林 立即启动 不考虑LDL水平 强化他汀 降压达标 动脉到动脉栓塞 阿司匹林＋氯吡格雷一周后改为氯吡格雷 立即启动 不考虑LDL水平 强化他汀 降压达标 低灌注／栓子清除障碍 阿司匹林＋氯吡格雷一周后改为氯吡格雷 立即启动 不考虑LDL水平 强化他汀 谨慎降压或停止降压 扩容 支架 心源性卒中 华法林 依据病因 启用他汀 标准他汀 降压达标 首选ARB 如果是冠心病所致，则他汀按冠心病相应选择用药 小血管病 阿司匹林／氯吡格雷 当LDL≥2.6mmol启用他汀 标准他汀 降压达标 首选ACEI/ARB Objectives The aim of this randomized placebo-controlled trial was to determine if withdrawing clopidogrel therapy leads to increased platelet activity compared with pre-treatment values in patients with stable coronary artery or peripheral arterial disease. Background Reports of increased cardiovascular events after planned cessation of clopidogrel therapy have raised concerns over the possible existence of a rebound in platelet activity. Methods In all, 171 patients receiving established aspirin therapy were randomly assigned to placebo or clopidogrel (75 mg daily) for 28 days. Blood samples were taken at pre-treatment baseline, on treatment just before discontinuation of study drug, and on days 7, 14, and 28 after discontinuation. The primary outcome measure was adenosine diphosphate (ADP)-stimulated platelet fibrinogen binding. Six secondary outcomes were assessed: ADP-stimulated platelet P-selectin, unstimulated platelet fibrinogen binding, and light transmission aggregometry with ADP 5 and 10 μmol/l recorded at maximum and at 6 min. Results The ADP-stimulated platelet fibrinogen binding, P-selectin expression, and platelet aggregation were lower on treatment with clopidogrel compared with baseline (p 0.0001), but returned to baseline levels by 7 days after discontinuation. Mixed