一级预防的抗栓:现状与未来.ppt
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1、Antithombosis in Primary Prevention Where do we stand/where are we going Dr. Carlos Brotons,Primary prevention trials with Aspirin: review of the Evidence,1988 British Doctors Trial 1998 Thrombosis Prevention Trial Hypertension Optimal Treatment (HOT) Study 1989 Physicians Health Study Primary Preve
2、ntion Project 2005 Womens Health Study,Meta-Analysis of Data from the Six Primary Prevention Trials of Cardiovascular Events Using Aspirin,Alfred A. Bartolucci, PhD*, and George Howard, DrPH,Am J Cardiol 2006; 98:746,Aspirin in the primary prevention of cardiovascular (CV) events,BDT, British Doctor
3、s Trial; HOT, Hypertension Optimal Treatment; PHS, Physicians Health Study; PPP, Primary Prevention Project; qod, every other day; TPT, Thrombosis Prevention Trial; WHS, Womens Health Study. 1. Peto R, et al. BMJ 1988;296:3136; 2. Physicians Health Study. N Engl J Med 1989;321:18258; 3. Hansson L, e
4、t al. Lancet 1998;351:175562. 4. The Medical Research Councils General Practice Research Framework. Lancet 1998;351: 23341; 5. de Gaetano G, et al. Lancet 2001;357:8995. 6. Ridker PM, et al. N Engl J Med 2005;352:1293304.,Primary findings (total CV events) from the six key trials,Odds Ratio and 95%
5、CI,0.5,1,2,ASPIRIN,CONTROL/ PLACEBO,Peto R, et al. BMJ 1988;296:3136; Physicians Health Study. N Engl J Med 1989;321:18258; Manson JE, et al. JAMA 1991;266:5217; Hansson L, et al. Lancet 1998;351:175562. The Medical Research Councils General Practice Research Framework. Lancet 1998;351:23341; de Gae
6、tano G. Lancet 2001;357:8995. Ridker PM, et al. N Engl J Med 2005;352:1293304.,Results of the Meta-analysis regarding the prevention of coronary heart disease,The overall risk reduction of total CHD (nonfatal and fatal MI and death due to CHD) was in favor of aspirin therapy (odds ratio of 0.77),BDT
7、,PHS,HOT,PPP,WHS,Combined,TPT,0.5 1 2,Favours aspirin Favours placebo,Odds ratio and 95% CI,CHD, coronary heart disease Bartolucci AA, et al. Am J Cardiol 2006;98:74650. .,Bartolucci AA, et al. Am J Cardiol 2006;98:74650.,Meta-analysis of six primary prevention trials showed no differences for the p
8、revention of stroke (OR 0.945; p=0.336),Results of the Meta-analysis regarding the prevention of the stroke,BDT,TPT,HOT,PPP,Combined,WHS,PHS,0.5 1 2,Odds ratio and 95% CI,Favours aspirin Favours placebo,Aspirin for the Primary Prevention of Cardiovascular Events in Women and Men,A Sex-Specific Meta-
9、analysis of Randomized Controlled Trials,Berger JS. JAMA 2006;306,32%,Effect of Aspirin Treatment on the Primary Prevention of Myocardial Infarction,17%,Effect of Aspirin Treatment on the Primary Prevention of Stroke, Ischemic Stroke and Hemorrhagic Stroke,24%,Effect of Aspirin Treatment on the Prim
10、ary Prevention of Ischemic Stroke,32%,28%,Effect of Aspirin Treatment on Major Bleeding,Absolute risk is very low: less than 1%,Reduction in serious vascular events with antiplatelet therapy in high-risk patients 287 studies, 135.000 patients,Category % odds reduction Acute MI Acute stroke Prior MI
11、Prior stroke/transient ischemic attack Other high risk: Coronary artery disease (e.g., unstable angina, heart failure) Peripheral arterial disease (e.g., intermittent claudication) High risk of embolism (e.g., atrial fibrillation) Other (e.g., diabetes mellitus) All trials 22% 2,1.0,0.5,0.0,1.5,2.0,
12、Control,Antiplatelet,MI, myocardial infarction Antithrombotic Trialists Collaboration. BMJ. 2002; 324:7186,Reduction in serious vascular events with antiplatelet therapy in high-risk patients 287 studies, 135.000 patients,*Antithrombotic Trialists Collaboration. BMJ 2002;324:71,75-150 mg aspirin dai
13、ly is considered routinely for all such patients at higher risk of vascular events (more than 2% a year) irrespective of whether they have already a major vascular event,Major CV events Relative risk reduction vs absolute risk reduction,HIGH RISK PATIENTS*,LOW RISK PATIENTS*,RRR 22 15,ARR 25 per 100
14、0 treated NNT 40 3 per 1000 treated NNT 333,*Antithrombotic Trialists Collaboration. BMJ 2002;324:71 * Meta-analysis of RCT. JAMA 2006;296,Major CV events Relative risk reduction vs absolute risk reduction,ALTHOUGH RELATIVE BENEFITS APPEARED BROADLY SIMILAR IN HIGH RISK AND LOW RISK PATIENTS THE ABS
15、OLUTE BENEFITS IN LOW RISK PATIENTS IS VERY SMALL.,*Antithrombotic Trialists Collaboration. BMJ 2002;324:71 * Meta-analysis of RCT. JAMA 2006;296,Guidelines support the use of aspirin for primary prevention of CV events,European guidelines on CVD prevention in clinical practice (2007) American Heart
16、 Association (AHA) http:/www.americanheart.org/ Evidence-based AHA guidelines for CVD prevention in women (2007 update). The guide to clinical preventive services 2008: recommendations of the U.S. Preventive Services Task Force (USPSTF). American College of Chest Physicians E-B Clinical Practice Gui
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