缺血性脑血管病的治疗进展推荐.ppt

* Slide 3 Atherothrombosis: a Generalized and Progressive Process Atherothrombosis is the common underlying disease process for MI, ischemia and vascular death. ACS are classic examples of atherothrombosis (plaque rupture and thrombus formation). ACS (in common with ischemic stroke and critical leg ischemia) are typically caused by rupture or erosion of an atherosclerotic plaque followed by formation of a platelet-rich thrombus. Atherosclerosis is an ongoing process affecting mainly large and medium-sized arteries, which can begin in childhood and progress throughout a person’s lifetime. Stable atherosclerotic plaques may encroach on the lumen of the artery and cause chronic ischemia, resulting in (stable) angina pectoris or intermittent claudication, depending on the vascular bed affected. Unstable atherosclerotic plaques may rupture, leading to the formation of a platelet-rich thrombus that partially or completely occludes the artery and causes acute ischemic symptoms. * * 幻灯片9 血小板上含有许多激活介质的受体，如血栓素A2、凝血酶原、ADP及其他等。这些介质通过许多内在反应激活血小板，其最终反应为激活纤维蛋白原结合位点，也就是糖蛋白Ⅱb/IIIa受体。通过激活糖蛋白Ⅱb/IIIa受体与纤维蛋白原结合并最终引起血小板的聚集和血栓形成。 * MATCH试验的目的是：在有近期*短暂脑缺血发作（TIA）或缺血性中风（IS）的高危严重血管事件病例，评价ASA 75 mg 加氯吡格雷75 mg与单用氯吡格雷75 mg相比，降低缺血性事件（脑血管和心血管）的长期（18个月）有效性 MATCH试验的目的还有：评价ASA 75 mg 加氯吡格雷75 mg与单用氯吡格雷75 mg相比的安全性。 *随机分组3个月内 * MATCH 试验将评价下述终点: 主要有效性终点: 综合有效性终点包括：首次出现心肌梗塞 (MI)、缺血性中风 (IS)、血管性死亡 (VD)或因急性缺血性事件再住院(因TIA、心绞痛或周围动脉疾病恶化再住院)。 次要有效性终点: 首次出现下列各项之一，或在随访的18月中再次出现这些事件: VD, MI 或 IS; 任何中风; 任何死亡; 非致命性 MI, 非致命性 IS, 或因急性缺血性事件再住院 (综合) * MATCH 试验将评价下述安全性终点: 安全性 根据下列副反应评价了长期安全性: 危及生命并严重的出血事件 所有出血事件 任何不良事件 身体各系统的不良事件 特殊不良事件，如皮疹/荨麻疹、紫癜、腹泻、粒细胞减少症、血小板减少症 * A total of 7,601 high-risk patients with recent transient ischemic attack or ischemic stroke (maximum within 3 months of the event) from 28 countries have been enrolled into MATCH. The patients are randomized to receive either 75 mg/day clopidogrel plus 75 mg/day ASA or 75 mg/day clopidogrel plus placebo for a period of 18 months. All treatments