缺血性卒中抗栓循证治疗.pptVIP

缺血性卒中抗栓循证治疗演示文稿;（优选）缺血性卒中抗栓循证治疗;急性缺血性卒中溶栓治疗;概述;与安慰剂相比，3h内IVrtPA(0.9mg/kg)能改善90天时的预后

出血发生率为6.4%，安慰剂为0.6%，但死亡率无差异

所有亚组预后均优于安慰剂组

益处可持续1年;随机,多中心,双盲,安慰剂对照

620例;排除CT早期梗塞灶(预后不良)

干预

rtPA(1.1mg/kg)vs.placebo

起病6h内

主要终点

BarthelIndexandmodifiedRankinScaleat90days

rtPA与安慰剂组无明显差别;随机,多中心,双盲,安慰剂对照

800例;排除CT早期明显梗塞灶

干预

rtPA(0.9mg/kg)vs.placebo

起病6h内

主要终点

modifiedRankinScaleScoreof≤1at90days

rtPA与安慰剂组无明显差别

;随机,多中心,双盲,安慰剂对照

613例

干预

rtPA(0.9mg/kg)vs.placebo

起病3-5h内

主要终点

NIHSSof≤1at90days

rtPA与安慰剂组无明显差别

;rt-PA:

小结;链激酶（SK）

;动脉溶栓;与安慰剂相比,6h内予IAProUK经造影证实MCAM1或M2段阻塞的患者有效.I类证据

15%绝对有效(numberneededtotreat=7)

增加颅内出血，死亡率无差异;急性椎基底动脉阻塞;小结;急性缺血性卒中抗凝治疗;概述;Summary:trialresults;各卒中亚型急性抗凝治疗

;各卒中亚型急性抗凝治疗:小结;小结;急性缺血性卒中阿司匹林治疗;

InternationalStrokeStrial(IST);ChineseAcuteStrokeTrial(CAST)

Lancet1997;349:1641;小结;非心源性卒中二级预防：

抗栓治疗;概述;Aspirin;高剂量阿司匹林随机对照试验;低剂量阿司匹林随机对照试验;AntiplateletTrialists’;Isthereaconsensus.;Ticlopidine;TASSStudy:Efficacy*;;Clopidogril;;;ManagementofAtherothrombosiswithClopidogrelinHigh-riskpatients（MATCH）;TheSecondEuropeanStrokePreventionStudy:

ESPS-2;ESPS-2Results:

StrokeRatesat24Months;ESPS-2:SideEffectProfile;Meta-Analysis:ASA/DPvsASA;PreventionRegimenforEffectivelyAvoidingSecondStrokes（PRoFESS）;Warfarin-AspirinRecurrentStrokeStudy（WARSS）;TheWarfarin-AspirinSymptomaticIntracranialDiseasestudy（WASID）;EffectofTreatmentonRecurrentIschemicStrokeandDeathAtTwoYearsinAPASS/WARSS

(Brey,RL:presentedatthe27InternationalStrokeConference,SanAntonio,TX,February9,2002);颈动脉和椎动脉夹层;

心源性卒中预防：

抗血栓治疗;心源性卒中可能病因;Rheumaticmitralvalvedisease:

2°strokeprevention;Prostheticheartvalves:mechanicalvalves

1°strokeprevention;Prostheticheartvalves:mechanicalvalves

2°strokeprevention;Prostheticheartvalves:

bioprostheticvalves;MitralValveProlapse:2°strokeprevention;Atherosclerosisofthethoracicaorta:

benefitofOAC;主动脉弓粥样硬化