张小宁中国缺血性脑卒中指南解读课件.pptVIP

心源性栓塞的抗栓治疗 * 对于心房颤动（包括阵发性）的缺血性脑卒中/TIA患者，推荐使用适当 剂量的华法林口服抗凝治疗，以预防再发血栓事件。华法林的目标剂量 是维持INR在2.0～3.0。 Ⅰ/ A 对于不能接受抗凝治疗的患者，推荐使用抗血小板治疗。 Ⅰ/ A 氯比格雷联合阿司匹林优于单用阿司匹林。 Ⅰ/ A Take home message 病因诊断是二级预防实施的前提 急诊室是二级预防的第一战线，尽早启动卒中二级预防，降低进展和复发率； 卒中后早期短期联合氯吡格雷＋阿司匹林抗血小板治疗，可能对降低卒中复发率更为有效，仍需要更充分的的研究证据以进一步证实临床获益 针对卒中高危（ESSEN?3分）患者，预防缺血性事件复发，波立维优于阿司匹林，具有良好的安全性，长期治疗获益显著； Thanks for your time Thanks！ * * * 预防治疗同步 * All rates shown are for patients referred to the study clinic. 90 d CVA risk 10.3% to 2.1% (p0.0001) NNT=12; 80% RRR for those treated in the EXPRESS clinic. NNT to prevent the combined outcome of CVA, MI and death also 12. For all patients presenting with suspected TIA in the county irrespective of treatment site, recurrent CVA declined from 9.9% to 4.2% (NNT 18) also statistically significant, but on subgroup analysis most of that improvement stemmed from the impact of those referred to the EXPPRESS clinic. Phase II patients at 30 days were significantly more likely to be on ASA/Clopidogrel, on a statin, on BP meds, have a lower BP and to have had CEA 7d and 30d after the event. The overall rate of CEA was not different between groups. No evidence of gradual improvement in TIA outcome as would be expected for some of overall diffusion of better medical therapy in the community: 9.3% [14/151] in months 1-15; 11.3% [18/159] in months 16-30; 2.5% [3/121] in months 31-45; and 1.9% [3/160] in months 46?60. In their population, they estimated 10 000 strokes per year could be prevented. Harms: no increase in 30 d bleeding events, including ICH in Phase II EXPRESS on the whole much more likely to be generalizable due to its methods: 1 Prospective and consecutive (before vs after) study2 Nested within large population-based incidence study of all TIA and stroke in strictly defined and stable population, with complete ascertainment of all presenting events in both study periods3 Primary analysis based on effect of clinic on outcome of all events in whole study population, irrespect