[临床医学]会议.ppt

* * * 抗栓协作组比较了有关阿司匹林的65项试验研究，调查不同剂量阿司匹林在高危血管性事件患者中的作用。严重血管性事件包括非致命性心肌梗死、非致命性卒中、血管性死亡或不明原因的死亡。结果发现所有剂量的阿司匹林均可减少血管性事件的危险性。最大剂量阿司匹林500-1500mg可减少血管性事件19%。阿司匹林剂量在160-325mg时可减少血管性事件危险性达26%，阿司匹林剂量在75-150mg、75 mg时减少血管性事件的危险分别为32%和13%。 References 1 Antithrombotic Trialists’ Collaboration. Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. BMJ. 2002;324:71-86. The effects of clopidogrel and ASA alone and in combination were evaluated in a pig model of stent thrombosis, under high-shear conditions. Clopidogrel administration resulted in rapid and dose-dependent inhibition of stent thrombosis, whereas ASA alone had minimal effects. When administered together, there was synergy between ASA and clopidogrel, and the combination resulted in 95–98% inhibition of stent thrombosis. Reference: 1. Makkar RR et al. Eur Heart J 1998; 19: 1538–46. * * CURE研究:发表于《新英格兰医学杂志》,在阿司匹林基础上联合氯吡格雷(负荷剂量300 mg,以后75 mg/d)使非ST段抬高冠脉综合征(NSTE -ACS)患者心血管死亡、MI和卒中危险显著降低20%,给药24小时内即出现终点事件减少,并持续至12个月。该研究确立了氯吡格雷75 mg在NSTE-ACS急性期应用的地位。 * * CURE研究中，对中途撤回知情同意退出试验的患者（不包括因不良反应退出研究的患者）进行随访，两组中该部分患者均近600例，平均治疗时间（退出试验的时间）为3个月左右。 结果显示，虽然两组间差异在3个月时最明显，但停药后氯吡格雷组患者逐渐丧失其从最初两联抗血小板治疗中的获益，在12个月时两组患者的事件发生率几乎相等。 因此，我们有理由认为，NSTE ACS的患者需要长期接受两联抗血小板治疗。但到底应治疗多长期，目前还没有研究可以回答这个问题。 1st Co-Primary Outcome: Subgroup of Patients Who Permanently Discontinued Study Drug Due to “Withdrawal of Consent” (N=596 Clop, 561 Plac): ITT Analysis of First Primary Event in Study * 氯吡格雷75mg在NSTE ACS的证据 Fox et al sought to further explore the benefits of antiplatelet therapy in reducing the risk of cardiac events in patients with acute coronary syndrome and the risks of this therapy in increasing the risk of bleeding by analyzing results from the Clopidogrel in Unstable angina to prevent Recurrent ischemic Events (CURE) trial. The CURE trial randomized 12,562 patients to receive clopidogrel or placebo in addition to aspirin. Primary outcomes we