如何权衡抗血小板治疗的获益与风险

如何权衡抗血小板治疗的获益与风险How to Balance the Benefit & Risk of Antiplatelet Therapy 上海交通大学附属瑞金医院心脏科 施仲伟阿司匹林高危患者二级预防的效益• 任何严重血管事件减少四分之一• 非致死性心肌梗死减少三分之一• 非致死性脑卒中减少四分之一• 心脑血管病死亡率降低六分之一• 对其他原因死亡无不良影响 Antithrombotic Trialists’ Collaboration. BMJ 2002, 324:71–86上海瑞金医院施仲伟The CURE Trial Investigators. N Engl J Med 2001, 345:4940.000.020.040.060.080.100.120.14Cumulative Hazard RateClopidogrel + ASA369Placebo + ASAMonths of Follow-Up11.4%9.3%20% RRRP < 0.001n = 12 562012Primary End Point: MI/Stroke/CV DeathCURE上海瑞金医院施仲伟CURE: Bleeding EpisodesThe CURE Trial Investigators. N Engl J Med 2001, 345:494EventMajor bleedingLife-threateningOther major bleedingTransfusions of 2 units Minor bleedingASA + Placebo(n = 6 303)ASA + Clopidogrel(n = 6 259)p value2.7 %1.8 %0.9 %2.2 %2.4%3.7 %2.2 %1.5 %2.8 %5.1 %0.0010.130.0020.02< 0.001上海瑞金医院施仲伟使用阿司匹林：效益 - 风险比是否合理上海瑞金医院施仲伟阿司匹林大出血风险：每千人每年增加 1.3 例*0.2 0.5 1 2 5RR(95%CI)1.71 (1.08-2.73)0.73 (0.33-1.64)2.25 (1.03-4.90)1.40 (0.40-4.93)1.84 (0.68-4.96)2.83 (1.32-6.05)1.74 (1.32-2.30)1.56 (0.78-3.13)1.71 (1.41-2.08)PHSPreliminary report of the Stroke Prevention in Atrial FibrillationStudy/Stroke Prevention in Atrial Fibrillation StudySwedish Aspirin Low-Dose Trial(SALT)EAFT (European Atrial Fibrillation Trial) Study GroupThrombosis prevention trial: randomised trial of low-intensity oralanticoagulation with warfarin and low-dose aspirin in the primaryprevention of ischaemic heart disease in men at increased risk.Collaborative Group of the Primary Prevention Project.HOT StudyThe Swedish Angina Pectoris Aspirin Trial (SAPAT) Summary利于阿司匹林 利于安慰剂McQuaid KR, et al. Am J Med 2006, 119:624-...