Neurology：CHANCE研究：双抗治疗轻型卒中/TIA获益主要在前2周

2017-05-18 佚名中国循环杂志

近日，Neurology杂志发表了我国学者王拥军、王伊龙等开展的CHANCE研究的最新成果：轻型卒中或TIA患者早期采用阿司匹林+氯吡格雷双联抗血小板治疗的净获益可能在最初2周内，净获益主要是指新发缺血性卒中减少的益处超出血增加的风险。研究数据显示，氯吡格雷-阿司匹林双联抗血小板治疗在前2周可以减少新发缺血性卒中风险，但在第3周新发缺血性卒中事件在数值上有所增加。而在出血方面，氯吡格雷-阿司匹林双

近日，Neurology杂志发表了我国学者王拥军、王伊龙等开展的CHANCE研究的最新成果：轻型卒中或TIA患者早期采用阿司匹林+氯吡格雷双联抗血小板治疗的净获益可能在最初2周内，净获益主要是指新发缺血性卒中减少的益处超出血增加的风险。

研究数据显示，氯吡格雷-阿司匹林双联抗血小板治疗在前2周可以减少新发缺血性卒中风险，但在第3周新发缺血性卒中事件在数值上有所增加。

而在出血方面，氯吡格雷-阿司匹林双联抗血小板治疗在最初的4周任意出血风险高于阿司匹林单抗治疗。

在氯吡格雷-阿司匹林双联抗血小板治疗组，最初1月内共有4例中度到中度出血，1例发生在第1周，2例在第2周，1例在第3周。阿司匹林组最初1月无中重度出血事件。

进一步分析显示，氯吡格雷+阿司匹林双联抗血小板治疗减少的新发缺血性卒中事件和增加的出血事件数的差别随着双抗治疗时间的延长逐渐变小，曲线在第10天的时候交叉。

关于临床净获益的敏感性分析显示，如果出血相较于新发缺血性卒中权重为0.8或者更低，则双抗治疗在前2周具有正向的净获益。

目前中国与美国AHA/ASA指南关于急性缺血性卒中早期管理的指南中，均推荐轻型卒中及TIA应用氯吡格雷+阿司匹林治疗21天。

Neurology杂志对于文章的发表也给予了高度的重视和赞赏。

原始出处：

Pan Y， Jing J， Chen W，et al. Risks and benefits of clopidogrel-aspirin in minor stroke or TIA： Time course analysis of CHANCE. Neurology. 2017 May 16.

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2017-08-30 tcm111hq

#轻型卒中#

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2017-05-21 yinhl1978

#Neurol#

29 0
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2017-06-07 I come

学习了谢谢分享

52 0
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2017-06-03 I come

精准医学的证据

1 0
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2017-05-20 chendoc247

#CHANCE#

26 0
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2017-05-20 chendoc247

#CHANCE#

33 0
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style='color:#2F92EE;'>#CHANCE#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=4579, encryptionId=c99f45e9dc, topicName=CHANCE)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=daed14955633, createdName=chendoc247, createdTime=Sat May 20 08:18:00 CST 2017, time=2017-05-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1487223, encodeId=a3c1148e2235a, content=<a href='/topic/show?id=334b3e46139' target=_blank style='color:#2F92EE;'>#双抗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37461, encryptionId=334b3e46139, topicName=双抗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=bbaa8296156, createdName=yeye5224615, createdTime=Sat May 20 08:18:00 CST 2017, time=2017-05-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1429115, encodeId=13d2142911547, content=<a href='/topic/show?id=168a3e464ad' target=_blank style='color:#2F92EE;'>#双抗治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37464, encryptionId=168a3e464ad, topicName=双抗治疗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=4f6a4173831, createdName=zhangbaojun, createdTime=Sat May 20 08:18:00 CST 2017, time=2017-05-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=200039, encodeId=e77f200039b3, content=这个是个不错的研究观点, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=eff51996281, createdName=1e1b8538m79(暂无匿称), createdTime=Fri May 19 16:11:33 CST 2017, time=2017-05-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=199929, encodeId=24f31999290d, content=那就是前两周给予双抗，之后就阿司匹林单抗就可以了, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/DYAIOgq83epcEuqMhg8HWu4Gq5Q6dXbZoOZUHP9R4CPzic54riasPo87A9c46h3NIMWiaoiatjoEbw32hEA86rD4zg/132, createdBy=37942047541, createdName=玲儿0000, createdTime=Fri May 19 09:31:30 CST 2017, time=2017-05-19, status=1, ipAttribution=)]
2017-05-20 yeye5224615

#双抗#

27 0
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createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6KcicAVC1MwuK9CDibOwszLoEBg36ZXqzB5NDasNV9GTfFDmBicM1V8hUS4OtTicG3IiaFIKq4wqD23LUxORRJXqjVs/0, createdBy=00e81647535, createdName=I come, createdTime=Sat Jun 03 07:01:22 CST 2017, time=2017-06-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1564268, encodeId=6ada156426884, content=<a href='/topic/show?id=c99f45e9dc' target=_blank style='color:#2F92EE;'>#CHANCE#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=4579, encryptionId=c99f45e9dc, topicName=CHANCE)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=daed14955633, createdName=chendoc247, createdTime=Sat May 20 08:18:00 CST 2017, time=2017-05-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1558259, encodeId=1c071558259ea, content=<a href='/topic/show?id=c99f45e9dc' target=_blank style='color:#2F92EE;'>#CHANCE#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=4579, encryptionId=c99f45e9dc, topicName=CHANCE)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=daed14955633, createdName=chendoc247, createdTime=Sat May 20 08:18:00 CST 2017, time=2017-05-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1487223, encodeId=a3c1148e2235a, content=<a href='/topic/show?id=334b3e46139' target=_blank style='color:#2F92EE;'>#双抗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37461, encryptionId=334b3e46139, topicName=双抗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=bbaa8296156, createdName=yeye5224615, createdTime=Sat May 20 08:18:00 CST 2017, time=2017-05-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1429115, encodeId=13d2142911547, content=<a href='/topic/show?id=168a3e464ad' target=_blank style='color:#2F92EE;'>#双抗治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37464, encryptionId=168a3e464ad, topicName=双抗治疗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=4f6a4173831, createdName=zhangbaojun, createdTime=Sat May 20 08:18:00 CST 2017, time=2017-05-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=200039, encodeId=e77f200039b3, content=这个是个不错的研究观点, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=eff51996281, createdName=1e1b8538m79(暂无匿称), createdTime=Fri May 19 16:11:33 CST 2017, time=2017-05-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=199929, encodeId=24f31999290d, content=那就是前两周给予双抗，之后就阿司匹林单抗就可以了, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/DYAIOgq83epcEuqMhg8HWu4Gq5Q6dXbZoOZUHP9R4CPzic54riasPo87A9c46h3NIMWiaoiatjoEbw32hEA86rD4zg/132, createdBy=37942047541, createdName=玲儿0000, createdTime=Fri May 19 09:31:30 CST 2017, time=2017-05-19, status=1, ipAttribution=)]
2017-05-20 zhangbaojun

#双抗治疗#

35 0
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createdBy=8217292, createdName=yinhl1978, createdTime=Sun May 21 11:18:00 CST 2017, time=2017-05-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=207532, encodeId=d58f20e53276, content=学习了谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6KcicAVC1MwuK9CDibOwszLoEBg36ZXqzB5NDasNV9GTfFDmBicM1V8hUS4OtTicG3IiaFIKq4wqD23LUxORRJXqjVs/0, createdBy=00e81647535, createdName=I come, createdTime=Wed Jun 07 06:48:50 CST 2017, time=2017-06-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=205846, encodeId=595520584698, content=精准医学的证据, beContent=null, objectType=article, channel=null, level=null, likeNumber=1, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6KcicAVC1MwuK9CDibOwszLoEBg36ZXqzB5NDasNV9GTfFDmBicM1V8hUS4OtTicG3IiaFIKq4wqD23LUxORRJXqjVs/0, createdBy=00e81647535, createdName=I come, createdTime=Sat Jun 03 07:01:22 CST 2017, time=2017-06-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1564268, encodeId=6ada156426884, content=<a href='/topic/show?id=c99f45e9dc' target=_blank style='color:#2F92EE;'>#CHANCE#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=4579, encryptionId=c99f45e9dc, topicName=CHANCE)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=daed14955633, createdName=chendoc247, createdTime=Sat May 20 08:18:00 CST 2017, time=2017-05-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1558259, encodeId=1c071558259ea, content=<a href='/topic/show?id=c99f45e9dc' target=_blank style='color:#2F92EE;'>#CHANCE#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=4579, encryptionId=c99f45e9dc, topicName=CHANCE)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=daed14955633, createdName=chendoc247, createdTime=Sat May 20 08:18:00 CST 2017, time=2017-05-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1487223, encodeId=a3c1148e2235a, content=<a href='/topic/show?id=334b3e46139' target=_blank style='color:#2F92EE;'>#双抗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37461, encryptionId=334b3e46139, topicName=双抗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=bbaa8296156, createdName=yeye5224615, createdTime=Sat May 20 08:18:00 CST 2017, time=2017-05-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1429115, encodeId=13d2142911547, content=<a href='/topic/show?id=168a3e464ad' target=_blank style='color:#2F92EE;'>#双抗治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37464, encryptionId=168a3e464ad, topicName=双抗治疗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=4f6a4173831, createdName=zhangbaojun, createdTime=Sat May 20 08:18:00 CST 2017, time=2017-05-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=200039, encodeId=e77f200039b3, content=这个是个不错的研究观点, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=eff51996281, createdName=1e1b8538m79(暂无匿称), createdTime=Fri May 19 16:11:33 CST 2017, time=2017-05-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=199929, encodeId=24f31999290d, content=那就是前两周给予双抗，之后就阿司匹林单抗就可以了, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/DYAIOgq83epcEuqMhg8HWu4Gq5Q6dXbZoOZUHP9R4CPzic54riasPo87A9c46h3NIMWiaoiatjoEbw32hEA86rD4zg/132, createdBy=37942047541, createdName=玲儿0000, createdTime=Fri May 19 09:31:30 CST 2017, time=2017-05-19, status=1, ipAttribution=)]
2017-05-19 1e1b8538m79(暂无匿称)

这个是个不错的研究观点

59 0
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createdBy=8217292, createdName=yinhl1978, createdTime=Sun May 21 11:18:00 CST 2017, time=2017-05-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=207532, encodeId=d58f20e53276, content=学习了谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6KcicAVC1MwuK9CDibOwszLoEBg36ZXqzB5NDasNV9GTfFDmBicM1V8hUS4OtTicG3IiaFIKq4wqD23LUxORRJXqjVs/0, createdBy=00e81647535, createdName=I come, createdTime=Wed Jun 07 06:48:50 CST 2017, time=2017-06-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=205846, encodeId=595520584698, content=精准医学的证据, beContent=null, objectType=article, channel=null, level=null, likeNumber=1, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6KcicAVC1MwuK9CDibOwszLoEBg36ZXqzB5NDasNV9GTfFDmBicM1V8hUS4OtTicG3IiaFIKq4wqD23LUxORRJXqjVs/0, createdBy=00e81647535, createdName=I come, createdTime=Sat Jun 03 07:01:22 CST 2017, time=2017-06-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1564268, encodeId=6ada156426884, content=<a href='/topic/show?id=c99f45e9dc' target=_blank style='color:#2F92EE;'>#CHANCE#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=4579, encryptionId=c99f45e9dc, topicName=CHANCE)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=daed14955633, createdName=chendoc247, createdTime=Sat May 20 08:18:00 CST 2017, time=2017-05-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1558259, encodeId=1c071558259ea, content=<a href='/topic/show?id=c99f45e9dc' target=_blank style='color:#2F92EE;'>#CHANCE#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=4579, encryptionId=c99f45e9dc, topicName=CHANCE)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=daed14955633, createdName=chendoc247, createdTime=Sat May 20 08:18:00 CST 2017, time=2017-05-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1487223, encodeId=a3c1148e2235a, content=<a href='/topic/show?id=334b3e46139' target=_blank style='color:#2F92EE;'>#双抗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37461, encryptionId=334b3e46139, topicName=双抗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=bbaa8296156, createdName=yeye5224615, createdTime=Sat May 20 08:18:00 CST 2017, time=2017-05-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1429115, encodeId=13d2142911547, content=<a href='/topic/show?id=168a3e464ad' target=_blank style='color:#2F92EE;'>#双抗治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37464, encryptionId=168a3e464ad, topicName=双抗治疗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=4f6a4173831, createdName=zhangbaojun, createdTime=Sat May 20 08:18:00 CST 2017, time=2017-05-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=200039, encodeId=e77f200039b3, content=这个是个不错的研究观点, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=eff51996281, createdName=1e1b8538m79(暂无匿称), createdTime=Fri May 19 16:11:33 CST 2017, time=2017-05-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=199929, encodeId=24f31999290d, content=那就是前两周给予双抗，之后就阿司匹林单抗就可以了, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/DYAIOgq83epcEuqMhg8HWu4Gq5Q6dXbZoOZUHP9R4CPzic54riasPo87A9c46h3NIMWiaoiatjoEbw32hEA86rD4zg/132, createdBy=37942047541, createdName=玲儿0000, createdTime=Fri May 19 09:31:30 CST 2017, time=2017-05-19, status=1, ipAttribution=)]
2017-05-19 玲儿0000

那就是前两周给予双抗，之后就阿司匹林单抗就可以了

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Neurology：CHANCE研究：双抗治疗轻型卒中/TIA获益主要在前2周

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