(临床医学)2009天坛会-缺血性卒中、TIA二级预防抗血小板药物规范化应用的中国专家共识.ppt

解读：缺血性卒中／TIA 二级预防抗血小板药物规范化应用的中国专家共识 抗血小板/抗凝预防卒中的重要手段 1 心源性脑栓塞的预防----抗栓药物 1 心源性脑栓塞的预防----抗栓药物 -W：OAC 优于ASA+Plav -A： ASA+Plav优于ASA单用 绝大多数推荐华法令，INR 2.0~3.0 低危一级预防患者，可阿司匹林：CHADS23分 不能耐受或不依从者，ASA+氯吡格雷合用！ 2 非AF患者脑梗死的二级预防 ATC荟萃分析：阿司匹林保护各种血管事件高危患者 非心源性脑栓塞二级预防 抗凝 Vs ASA 2.2 抗凝 VS 阿司匹林： NO OAC！ INR 3 出血，被否定！INR1，差于阿司匹林 INR 2-3：循证医学同样否定 2005年 WASID 研究：否定抗凝在症状性颅内动脉狭窄的预防作用。随访2年, 华法令(INR 2~3) VS ASA 1300mg 类似WARSS，卒中发生与血管性死亡无差异 2007 ESPRIT：动脉源性脑梗死，华法令 Vs ASA 同样否定华法令（INR 2-3）的作用！ 2.3 Aggenox? + ASA Vs ASAEuropean Stroke Prevention Study (ESPS) 2 Pairwise comparisons Relative risk P Value reduction 波立维75mg安全性至少与阿司匹林相当 ESO 2008 二级预防Antithrombotic Therapy Recommendations (1/4) Patients should receive antithrombotic therapy (Class I, Level A) Patients not requiring anticoagulation should receive antiplatelet therapy (Class I, Level A). Where possible, combined aspirin and dipyridamole, or clopidogrel alone, should be given. Alternatively, aspirin alone, or triflusal alone, may be used (Class I, Level A) Class I Recommendations 2. Old recommendation: Aspirin (50 to 325 mg/d), the combination of aspirin and extended-release dipyridamole, and clopidogrel are all acceptable options for initial therapy ( IIa, A). 3. Old recommendation: Compared with aspirin alone, both the combination of aspirin and extended-release dipyridamole and clopidogrel are safe. The combination of aspirin and extended-release dipyridamole is suggested over aspirin alone (Class IIa, Level of Evidence A). Class II Recommendations Class III Recommendation The addition of aspirin to clopidogrel increases the risk of hemorrhage. Combination therapy of aspirin and clopidogrel is not routinely recommended for ischemic stroke or TIA patients unless they have a specific indication for this therapy (ie, coronary stent or acute coronary syndrome) (I). ASA: effective. IA Aggenox? ASA IA Plavix? Clopidogrel