二级预防厦门hyn

脑卒中二级预防 强化抗血小板管理,N Engl J Med 2006,354:1,Clopidogrel and Aspirin versus Aspirin Alonefor the Prevention of Atherothrombotic Events,CHARISMA,阿司匹林、氯吡格雷加阿司匹林预防动脉粥样硬化事件的对照研究,CHARISMA,疗效分析,阿司匹林组与阿司匹林氯吡格雷组主要疗效无显著性差异,N Engl J Med 2006,354:1,疗效主要终点：心肌梗死、卒中、心血管死亡,CHARISMA,亚组分析,心脑血管疾病亚组：氯吡格雷组出血率显著增高,（）,2,0,6,4,主要终点事件,6.9,7.9,P=0.046,氯吡格雷组,阿司匹林组,严重出血率,1.6,1.4,P=0.39,中度出血率,2.1,1.3,P0.001,有症状亚组：入选时即有确诊的心脑血管疾病患者,n=12153,8,Unstable Angina Patients benefit from enhanced platelet inhibition only within the first weeks (CURE),Aspirin + Clopidogrel,Aspririn + placebo,after 4 weeks and after 4.5 Month,Added Benefit of Clopidogrel to ASA treatment in Unstaible Angina Patients,2x2 factorial design involving 20，000 stroke patients,Clopidogrel (75 mg) +ASA (75 mg) +placebo(3,875 pts),ER-DP + ASA (200 mg/25 mg) + placebo(3,875 pts),Placebo,Clopidogrel (75 mg) + ASA (75 mg) + Telmisartan(80mg)(3,875 pts),ER-DP + ASA (200 mg/25 mg) + Telmisartan(80mg)(3,875 pts),Clopidogrel +ASA,ER-DP + ASA,Telmisartan,- Trial Design,CLopidogrel plus ASA for Infarct Reduction in acute stroke / TIA patients with large artery stenosis and microembolic signals氯吡格雷联合阿司匹林与单用阿司匹林对于有大动脉狭窄和微栓子信号的急性脑卒中或短暂性脑缺血发作患者减少梗死的疗效比较,CLAIR: 参与中心,中国大陆黄一宁, 北京吕传真/付建辉 上海韩钊, 温州香港特别行政区威尔斯亲王医院: 黄家星马来西亚KS Tan,新加坡SGH: HM HM Chang, C Chen, 曼谷, 泰国Nijasri Suwanwela,Disya Ratanakorn台湾WJ WongKC Chang菲律宾J Navarro,10 or more patients randomized,CLAIR: 研究设计,CLAIR: 研究人群,卒中/TIA 200 ml/L,意向性治疗分析,MES阳性患者: 总体,氯吡格雷75mg联合ASA治疗第2天，MES的阳性率显著降低达42%,80%,70%,60%,50%,40%,30%,20%,10%,D1,2,7,D1,2,7,单药治疗ASA 75mg,联合治疗氯吡格雷75mg + ASA 75mg,67.3%,54.0%,51.0%,56.5%,31.1%,23.3%,意向性治疗分析,RR 42%, p=0.025,MES阳性患者比例,氯吡格雷75mg联合ASA治疗第7天，MES阳性率进一步显著降低达54.4%,80%,70%,60%,50%,40%,30%,20%,10%,D1,2,7,D1,2,7,单药治疗ASA 75mg,联合治疗氯吡格雷75mg + ASA 75mg,67.3%,54.0%,51.0%,56.5%,31.1%,23.3%,MES阳性患者比例,意向性治疗分析,RR 54.4%, p=0.006,DWI上急性梗死灶,D1和D7两组之间无显著差异,其他检测量表: 单药治疗组和联合治疗组无差异,NIHSSmRSMMSE巴氏量表,CLAIR: 阿司匹林单药治疗组有2例卒中复发氯吡格雷联合阿司匹林组未发现严重出血并发症和死亡,*2例为皮肤粘膜轻微出血,Unstable Angina Patients benefit from enhanced platelet inhibition only within the first weeks (CURE),Aspirin + Clopidogrel,Aspririn + placebo,after 4 weeks and after 4.5 Month,Added Benefit of Clopidogrel to ASA treatment in Unstaible Angina P