脑梗死急性期的抗血小板治疗阶梯工程PPT.ppt

脑梗死急性期相当一部分患者伴有高血压，由于急性期的主要茅盾是血栓形成及扩大，因此抗栓治疗仍然是重要治疗措施，荟萃分析显示即使对于高血压的患者，阿司匹林仍然能获益。 2000年ZhengMing Chen对国际卒中研究（IST）和中国急性卒中研究（CAST）进行荟萃分析，CAST研究共21106例起病48hrs内脑梗死患者，ASA160mg/d 和安慰剂，共4周；IST研究共19435例起病48hrs内脑梗死患者，在48小时内开始接受阿司匹林300mg/d或皮下肝素治疗. 共14天。 结果显示： 1、阿司匹林使急性缺血性卒中患者的脑梗死复发率、卒中或死亡的发生率显著下降，非梗死死亡和全因死亡也有一定的下降。 2、阿司匹林急性期治疗使每1000名患者脑梗死复发事件减少7例，卒中或死亡减少9例（有统计学差异），而出血性卒中或梗死后出血性转化增加仅2例（且无统计学差异），因此对急性脑梗死应用阿司匹林获益远远大于风险 3、针对高龄、高血压阿司匹林均可降低死亡率和梗死复发率，因此对于高龄和高血压的急性脑梗死患者在急性期是有证据支持使用阿司匹林的。 4、根据起始时间分组，发现，0－6小时应用阿司匹林的获益更显著，出血发生率很少，因此对于脑梗死急性期阿司匹林应尽早使用。 Indications for Early Aspirin Use in Acute Ischemic Stroke A Combined Analysis of 40 000 Randomized Patients From the Chinese Acute Stroke Trial and the International Stroke Trial ZhengMing Chen, MBBS, DPhil; Peter Sandercock, MD; HongChao Pan, DPhil; Carl Counsell, MD; Rory Collins, MBBS, MSc; LiSheng Liu, MD; JingXian Xie, MD; Charles Warlow, MD; Richard Peto, FRS; on behalf of the CAST and IST collaborative groups Background and Purpose—Long-term daily aspirin is of benefit in the years after ischemic stroke, and 2 large randomized trials (the Chinese Acute Stroke Trial [CAST] and the International Stroke Trial [IST]), with 20 000 patients in each, have shown that starting daily aspirin promptly in patients with suspected acute ischemic stroke also reduces the immediate risk of further stroke or death in hospital and the overall risk of death or dependency. However, some uncertainty remains about the effects of early aspirin in particular categories of patient with acute stroke. Methods—To assess the balance of benefits and risks of aspirin in particular categories of patient with acute stroke (eg,the elderly, those without a CT scan, or those with atrial fibrillation), a prospectively planned meta-analysis is presented of the data from 40 000 individual patients from both trials on events that occurred in the hospital during the scheduled treatment period (4 weeks in CAST, 2 weeks in IST), with 10 characteristics used to define 28 s