一级预防的抗栓-现状与未来.ppt

Aspirin in the primary prevention of cardiovascular (CV) events Primary findings (total CV events) from the six key trials Results of the Meta-analysis regarding the prevention of coronary heart disease Aspirin for the Primary Prevention of Cardiovascular Events in Women and Men Reduction in serious vascular events with antiplatelet therapy in high-risk patients287 studies, 135.000 patients Guidelines support the use of aspirin for primary prevention of CV events European guidelines on CVD prevention in clinical practice (2007) American Heart Association (AHA) / Evidence-based AHA guidelines for CVD prevention in women (2007 update). The guide to clinical preventive services 2008: recommendations of the U.S. Preventive Services Task Force (USPSTF). American College of Chest Physicians E-B Clinical Practice Guidelines- Antiplatelet Drugs (2008) European guidelines on CVD prevention in clinical practice Aspirin (75 mg daily) can be considered in all patients with CVD, and in those at high risk of developing CVD (SCORE 10% over 10 years) once blood pressure has been controlled (as closely as possible to the goal of less than 140/90 mmHg) In lower risk individuals a small absolute vascular benefit by aspirin maybe offset by the slightly greater absolute risk of bleeding complications American Heart Association (AHA) Guidelines Benefits of reducing CV risk outweigh these risks in most patients with higher coronary risk Doses of aspirin 75–160 mg per day are as effective as higher doses Consider aspirin 75–160 mg per day for people at higher risk (especially those with a 10-year CHD risk of 10 percent or greater) AHA guidelines for CVD prevention in women (2007 update) Aspirin: high-risk Any vascular disease, end-stage or chronic renal disease, diabetes mellitus, and 10-year Framingham risk 20% Aspirin therapy 75 to 325 mg per day should be used in high-risk women unless contraindicated (Class I, Level A) Guide to clinical preventive services 2008: recommendati