阿司匹林ww版(修改)ppt课件.ppt

* Paul等2005年在新英格兰杂志发表了阿斯匹林在一级预防中具有重要意义的妇女健康研究: 39,876例最初健康的女性（45岁以上）接受阿斯匹林100mg隔天一次，观察10年，结果显示：阿斯匹林显著降低女性首次卒中发生率达17%（RR0.83, 95%CI 0.69-0.99; P=0.04),其中缺血性卒中下降24%（RR0.763, 95%CI 0.63-0.93; P=0.009), TIA下降22%（RR0.78, 95%CI 0.64 to 0.94; P=0.01),同时未增加出血性卒中的风险。65岁以上女性亚组分析结果显示阿斯匹林显著减少主要血管事件（包括心肌梗死，卒中，血管事件死亡）达26%（RR0.74, 95%CI 0.59 to 0.92; P=0.008），降低心肌梗死发生率达34%（RR0.66, 95%CI 0.44 to 0.97；P=0.04）WHS为阿司匹林的一级预防提供了新的有力证据。 * WHS实验设计 * 65岁以上女性亚组分析结果显示阿斯匹林显著减少主要血管事件（包括心肌梗死，卒中，血管事件死亡）达26%（RR0.74, 95%CI 0.59 to 0.92; P=0.008），降低心肌梗死发生率达34%（RR0.66, 95%CI 0.44 to 0.97；P=0.04） * WHS三点结论 * 中国缺血性脑血管病阿司匹林规范应用共识初稿，王拥军等，2005 * * Reference: 1. Antithrombotic Trialists’ Collaboration. BMJ 2002; 324: 71–86. In order to evaluate the full body of evidence on the effectiveness of antiplatelet therapy, an updated collaborative overview of randomized trials of antiplatelet therapy among high-risk patients has been undertaken.1 This meta-analysis included all antiplatelet agent trials up until 1997, particularly new trials with ASA, clopidogrel and dipyridamole (notably the CAPRIE* trial and ESPS2?), that were not available for the previous antiplatelet trialists’ collaboration, published in 1994 (287 vs 145 trials respectively). 抗栓试验组对287个随机临床对照研究进行了荟萃分析，结果显示具有卒中或TIA病史的受试者服用抗血小板药物可以显著降低其总死亡率（P = 0.002)、血管性死亡率（P = 0.04)、非致命性血管事件（P = 0.002)、非致命性卒中（P 0.0001)和心肌梗死（P = 0.009)。其中阿斯匹林使受试者总血管事件降低23%。进一步分析结果显示阿司匹林最有效的二级预防剂量为75-150mg/d。 *Clopidogrel versus Aspirin in Patients at Risk of Ischemic Events ?European Stroke Prevention Study 2 * Reference: 1. Antithrombotic Trialists’ Collaboration. BMJ 2002; 324: 71–86. This slide compares risk reduction in a number of high-risk subgroups to the overall result, which demonstrated a consistent benefit across all patient groups with a mean of 22%.1 Stratified odds ratio of an event in treatment groups to that in control groups were plotted for each group of trials (white diamond) – along with a 99% confidence interval (horizontal line). ‘Other’ hig