小卒中及TIA二级预防研究进展.pptVIP

小卒中和TIA二级预防研究进展;主 要 内 容;二级预防的重点？;;;;小卒中/TIA后7天卒中发生率8-12％小卒中/TIA后90天卒中发生率17.9%;中国小卒中/TIA患者发病登记;Registry of the Canadian Stroke Network [RCSN], /pdf/RCSN_TechnicalReport_final.pdf) RACE登记，未发表数据；;小卒中/TIA应强调早期干预;早期干预与延迟干预比较显著降低90天卒中复发风险达80%！;早期积极干预，显著减少住院天数、住院花费和6个月致残率;2010中国卒中指南指出：二级预防应该从急诊室开始实施！;小卒中/TIA早期抗栓治疗策略;Kennedy J, et al. Lancet Neurol 2007;6:961?969;FASTER：早期联合使用氯吡格雷75mg与ASA未显著增加颅内出血风险;EARLY研究：卒中/TIA后24h内早期使用ASA+缓释双嘧达莫有降低血管事件风险的趋势;对颅内外大动脉狭窄伴MES阳性患者早期联合抗血小板治疗临床净获益更显著;; 治疗组 联合治疗 单药治疗 (氯吡格雷 + ASA) (ASA) 特征 (n=51) (n=56) 任何出血 2 (3.9) 1 (1.8) 致命性出血 0 0 大出血包括颅内出血 0 0 小出血 2 (3.9) 1 (1.8) 任何再发血管事件 TIA/缺血性卒中 5 (9.8) 12 (21.4) 狭窄同侧的TIA/缺血性卒中 4 (7.8) 11 (19.6) 缺血性卒中 0 4 (7.1) 心肌梗死 1 (2.0) 0 值用 n (%)来表示. 所有比较的P0.05.;氯吡格雷75mg联合ASA治疗第2天， MES的阳性率显著降低达42%;氯吡格雷75mg联合ASA治疗7天，进一步降低MES阳性率达54.4%;Graeme J Hankey Royal Perth Hospital, Perth, Australia ;Patients who suffer a TIA or ischemic stroke of noncardiac origin should be treated with an antiplatelet agent (Class I, Level A). Initial therapy should be ASA 75-162 mg once daily, clopidogrel 75 mg once daily, or ER-dipyridamole 200 mg twice daily plus ASA 25 mg twice daily (Class I, Level A). The choice of antiplatelet therapy regimen is determined by consideration of cost, tolerance, and other associated vascular conditions. Available data does not allow for differentiation of antiplatelet regimen by specific stroke subtype (Class IIb, Level C). The combination of ASA 75-162 mg daily plus clopidogrel 75 mg daily in the first month after TIA or minor ischemic stroke may be superior to aspirin alone in patients not at a high risk of bleeding (Class IIb, Level C). The combination of ASA 75-162 mg daily plus clopidogrel 75 mg daily should not be used for secondary stroke prevention beyond 1 month unless otherwise indicated and the risk of bleeding is low (Class III, Level B).;氯吡格雷+ASA联用 （早期短期联用，可能有前途）;卒中/T