Neurology:氯吡格雷-阿司匹林治疗小卒中或TIA的风险和获益

2017-06-01 吴星 环球医学

2017年5月,发表在《Neurology》上的CHANCE试验的分析,考察了氯吡格雷-阿司匹林治疗小卒中或TIA的风险和获益。目的:考察氯吡格雷联合阿司匹林治疗缺血性小卒中或TIA的短期风险和获益。方法:从急性非致残性脑血管事件高风险患者使用氯吡格雷(Clopidogrel in High-Risk Patients with Acute Nondisabling Cerebrovascular

2017年5月,发表在《Neurology》上的CHANCE试验的分析,考察了氯吡格雷-阿司匹林治疗小卒中或TIA的风险和获益。

目的:考察氯吡格雷联合阿司匹林治疗缺血性小卒中或TIA的短期风险和获益。

方法:从急性非致残性脑血管事件高风险患者使用氯吡格雷(Clopidogrel in High-Risk Patients with Acute Nondisabling Cerebrovascular Events,CHANCE)试验中获得数据。主要结局为新发缺血性卒中。安全性结局包括任何出血和中度至严重出血。时程分析考察卒中和出血结局。

结果:氯吡格雷-阿司匹林组的204例新发缺血性卒中和阿司匹林单药组的295例新发缺血性卒中之中,分别有145例(71.1%)、13例(6.4%)和12例(5.9%)vs 223例(75.6%)、19例(6.4%)和8例(2.7%)发生于第1、2、3周。氯吡格雷-阿司匹林组的60例出血和阿司匹林单药组的41例出血中,分别有23例(38.3%)、15例(25.0%)和9例(15.0%)vs 15例(36.6%)、8例(19.5%)和3例(7.3%)发生在第1、2、3周。在前2周内,氯吡格雷-阿司匹林治疗缺血性卒中风险的数值。从第10天开始,双联抗血小板减少新发卒中风险的获益超过的任何出血病例的数量。

结论:在小卒中或TIA患者中,与阿司匹林单药相比,氯吡格雷-阿司匹林治疗降低卒中风险的获益或超过潜在出血风险的增加,尤其在前2周。

证据分级:本研究提供了II级证据:对于小卒中或TIA患者,与阿司匹林单药相比,氯吡格雷联合阿司匹林在前2周内降低卒中风险超过增加的出血风险。

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  1. [GetPortalCommentsPageByObjectIdResponse(id=1999957, encodeId=b41c199995e1d, content=<a href='/topic/show?id=d5df12695e6' target=_blank style='color:#2F92EE;'>#Neurol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12695, encryptionId=d5df12695e6, topicName=Neurol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8217292, createdName=yinhl1978, createdTime=Thu Nov 16 02:24:00 CST 2017, time=2017-11-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=210393, encodeId=8e172103939e, content=收益, beContent=null, objectType=article, channel=null, level=null, likeNumber=93, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRpuZmDKpXl0f9xib2LxHVPvoMaXPBwFxyjwswq6KuQWeTIt1VWwQO4M1XSfVCq5gdWUd4eu0IMmMd/0, createdBy=2c612068694, createdName=134****2080, createdTime=Wed Jun 14 03:58:05 CST 2017, time=2017-06-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=205289, encodeId=f70e20528959, content=很好,有所了解,值得关注, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=387d1660055, createdName=dhzzm, createdTime=Thu Jun 01 17:07:25 CST 2017, time=2017-06-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=205284, encodeId=628c20528441, content=非常好的文章,学习了,很受益, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7LIiaRZTzJ3SEfiauCzTMPW7YvPPYLNJBXG9oh6Al1icq2VQQkIHWxqXehcicTS62YKJVBhxeth3wggw/0, createdBy=7ce01621306, createdName=天涯183, createdTime=Thu Jun 01 16:51:21 CST 2017, time=2017-06-01, status=1, ipAttribution=)]
    2017-11-16 yinhl1978
  2. [GetPortalCommentsPageByObjectIdResponse(id=1999957, encodeId=b41c199995e1d, content=<a href='/topic/show?id=d5df12695e6' target=_blank style='color:#2F92EE;'>#Neurol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12695, encryptionId=d5df12695e6, topicName=Neurol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8217292, createdName=yinhl1978, createdTime=Thu Nov 16 02:24:00 CST 2017, time=2017-11-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=210393, encodeId=8e172103939e, content=收益, beContent=null, objectType=article, channel=null, level=null, likeNumber=93, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRpuZmDKpXl0f9xib2LxHVPvoMaXPBwFxyjwswq6KuQWeTIt1VWwQO4M1XSfVCq5gdWUd4eu0IMmMd/0, createdBy=2c612068694, createdName=134****2080, createdTime=Wed Jun 14 03:58:05 CST 2017, time=2017-06-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=205289, encodeId=f70e20528959, content=很好,有所了解,值得关注, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=387d1660055, createdName=dhzzm, createdTime=Thu Jun 01 17:07:25 CST 2017, time=2017-06-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=205284, encodeId=628c20528441, content=非常好的文章,学习了,很受益, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7LIiaRZTzJ3SEfiauCzTMPW7YvPPYLNJBXG9oh6Al1icq2VQQkIHWxqXehcicTS62YKJVBhxeth3wggw/0, createdBy=7ce01621306, createdName=天涯183, createdTime=Thu Jun 01 16:51:21 CST 2017, time=2017-06-01, status=1, ipAttribution=)]
    2017-06-14 134****2080

    收益

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=1999957, encodeId=b41c199995e1d, content=<a href='/topic/show?id=d5df12695e6' target=_blank style='color:#2F92EE;'>#Neurol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12695, encryptionId=d5df12695e6, topicName=Neurol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8217292, createdName=yinhl1978, createdTime=Thu Nov 16 02:24:00 CST 2017, time=2017-11-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=210393, encodeId=8e172103939e, content=收益, beContent=null, objectType=article, channel=null, level=null, likeNumber=93, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRpuZmDKpXl0f9xib2LxHVPvoMaXPBwFxyjwswq6KuQWeTIt1VWwQO4M1XSfVCq5gdWUd4eu0IMmMd/0, createdBy=2c612068694, createdName=134****2080, createdTime=Wed Jun 14 03:58:05 CST 2017, time=2017-06-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=205289, encodeId=f70e20528959, content=很好,有所了解,值得关注, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=387d1660055, createdName=dhzzm, createdTime=Thu Jun 01 17:07:25 CST 2017, time=2017-06-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=205284, encodeId=628c20528441, content=非常好的文章,学习了,很受益, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7LIiaRZTzJ3SEfiauCzTMPW7YvPPYLNJBXG9oh6Al1icq2VQQkIHWxqXehcicTS62YKJVBhxeth3wggw/0, createdBy=7ce01621306, createdName=天涯183, createdTime=Thu Jun 01 16:51:21 CST 2017, time=2017-06-01, status=1, ipAttribution=)]
    2017-06-01 dhzzm

    很好,有所了解,值得关注

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=1999957, encodeId=b41c199995e1d, content=<a href='/topic/show?id=d5df12695e6' target=_blank style='color:#2F92EE;'>#Neurol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12695, encryptionId=d5df12695e6, topicName=Neurol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8217292, createdName=yinhl1978, createdTime=Thu Nov 16 02:24:00 CST 2017, time=2017-11-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=210393, encodeId=8e172103939e, content=收益, beContent=null, objectType=article, channel=null, level=null, likeNumber=93, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRpuZmDKpXl0f9xib2LxHVPvoMaXPBwFxyjwswq6KuQWeTIt1VWwQO4M1XSfVCq5gdWUd4eu0IMmMd/0, createdBy=2c612068694, createdName=134****2080, createdTime=Wed Jun 14 03:58:05 CST 2017, time=2017-06-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=205289, encodeId=f70e20528959, content=很好,有所了解,值得关注, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=387d1660055, createdName=dhzzm, createdTime=Thu Jun 01 17:07:25 CST 2017, time=2017-06-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=205284, encodeId=628c20528441, content=非常好的文章,学习了,很受益, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7LIiaRZTzJ3SEfiauCzTMPW7YvPPYLNJBXG9oh6Al1icq2VQQkIHWxqXehcicTS62YKJVBhxeth3wggw/0, createdBy=7ce01621306, createdName=天涯183, createdTime=Thu Jun 01 16:51:21 CST 2017, time=2017-06-01, status=1, ipAttribution=)]
    2017-06-01 天涯183

    非常好的文章,学习了,很受益

    0

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