如何权衡抗血小板治疗的获益与风险.pptxVIP

如何权衡抗血小板治疗的获益与风险第1页/共27页第2页/共27页第3页/共27页CURE11.4%Placebo + ASA9.3%Clopidogrel + ASA20% RRRP 0.001n = 12 562036912Months of Follow-UpPrimary End Point: MI/Stroke/CV DeathThe CURE Trial Investigators. N Engl J Med 2001, 345:494上海瑞金医院施仲伟第4页/共27页ASA + Placebo(n = 6 303)ASA + Clopidogrel(n = 6 259)Eventp valueMajor bleedingLife-threateningOther major bleedingTransfusions of ?2 units Minor bleeding2.7 %1.8 %0.9 %2.2 %2.4%3.7 %2.2 %1.5 %2.8 %5.1 %0.0010.130.0020.02 0.001CURE: Bleeding EpisodesThe CURE Trial Investigators. N Engl J Med 2001, 345:494上海瑞金医院施仲伟第5页/共27页使用阿司匹林：效益-风险比是否合理上海瑞金医院施仲伟第6页/共27页阿司匹林大出血风险：每千人每年增加1.3例*RR(95%CI)1.71 (1.08-2.73)0.73 (0.33-1.64)2.25 (1.03-4.90)1.40 (0.40-4.93)1.84 (0.68-4.96)2.83 (1.32-6.05)1.74 (1.32-2.30)1.56 (0.78-3.13)1.71 (1.41-2.08)PHSPreliminary report of the Stroke Prevention in Atrial FibrillationStudy/Stroke Prevention in Atrial Fibrillation StudySwedish Aspirin Low-Dose Trial(SALT)EAFT (European Atrial Fibrillation Trial) Study GroupThrombosis prevention trial: randomised trial of low-intensity oralanticoagulation with warfarin and low-dose aspirin in the primaryprevention of ischaemic heart disease in men at increased risk.Collaborative Group of the Primary Prevention Project.HOT StudyThe Swedish Angina Pectoris Aspirin Trial (SAPAT) Summary0.2 0.5 1 2 5* 每治疗769例患者1年发生1次大出血利于阿司匹林 利于安慰剂上海瑞金医院施仲伟McQuaid KR, et al. Am J Med 2006, 119:624-638第7页/共27页出血性卒中2总脑卒中心血管病死亡致死心肌梗死心肌梗死总死亡率0–3.1‰P=0.02+1.2‰P0.001–3.6‰P0.001–2–12‰P0.001–9.7‰P0.001–13.7‰P0.001–4心血管病事件发生率（每1000例患者）–6–8–10获益风险–12–14阿司匹林治疗获益远远大于风险16项试验55 462名患者，阿司匹林平均273mg/d，平均治疗37个月He J, et al. JAMA 1998, 280:1930-1935 上海瑞金医院施仲伟第8页/共27页第9页/共27页抗血小板药物使用原则之一：选择患者上海瑞金医院施仲伟第10页/共27页36 38 36 9 22每1000例患者受益 27 1 29 0.7 22平均治疗时间（月）0.0010.0010.001 0.0090.001P值阿司匹林安慰剂校正后的血管事件发生率％ATC汇总分析阿司匹林保护心血管事件高危患者Antithrombotic Trialists’ Collaboration. BMJ 2002;324: