规范应用阿司匹林治疗缺血性脑血管病的专家共识

????????????2006 ?6 ??3 ??2 ? J Neurol Neurorehabil , June 2006 , Vol. 3 ,No.2 ?????? ? ?????????????????????? (????????????????????) ??????? 1. ?? :???????????????? ??????，??????????????? ?(??????、????、????????? ????? ) 。??????????????? ?，?????????( IST) ????????? (CAST) 11,21，??????48 h ??????? ( IST?????????? 19 h ,CAST??25 h) o IST??????? 19 435 ???，????? ?????? 14 d ???????(9. 0%?9. 4% , P =0. 03 ) ，???????????? ( 2. 8% ? 3. 9% ，P <0.001) ，?????????????? ????(0 . 9% ?0. 8% ) ;??????? 6 ?? ??????致??????(61. 2% ?63. 5% , P = 0. 03 ) 。 CAST?????? 21 106 ????????， ??48 h ??????? 160 mg/ d，??4 ?。? ?????????????????( 3. 3% ? 3.9% ,P =0.04) ，??????????( 1. 6% ? 2. 1% ,P =0.01) ，????????????致? ????????????(30. 5%?31. 6%，P = 0. 08 ) ，???????????。 2 . ?? : ( 1)?????????????????? ?，????????，???100?300 mg/ d，? ? 2 - 4??????????????? 75 ? 150 mg/ d. (2)??????????????，???? ???24 h???????，???100---300 mg/ do (3 )????????????，?????? ?????????????。 3.?? :??????????，?????? 48 h ???。???????????????? ?????????????，???????? ????。????????????????? [??????1???( 1962 ?) ，?，???，??，?? ?，???????????????????。 ???????? ??????? ??? (TIA )????? 1.?? :?????? 287 ???????? ????????[3]，?????????TIA? ?????????????????????? ??(P =0.002) 、??????( P =0. 04 ) 、?致? ?? ?? ? ( P ?0. 002 ) 、?致? ?? ? ( P < 0.0001)?????( P =0. 009 )。??????? ?????????? 23% 。????????? ??????????????????? 75? 150 mg/ do ???????????? 1360 ????TIA ?????????75 mg/ d[4[，???????? ????????? 18% ( P =0. 02 )。??、?? ??TIA、?????????16%?20%o ???????? ?2 ????TIA ???? ????50 mg/ d，??????????? 18% , ?????13% '5' o 2. ?? : ( 1)????????? TIA( ??????? ???、?????? ) ???，???????? ??，????(75- - 150 mg/ d)???????? ?????????? ( aggrenox ) ????? (75 m?d ) 。 (2 )????????????????，?? ?????????，50---100 m?do (3)??????????，??????。 ????????? TIA ????? 1.?? :???????????????? ??(??)?????????〔3〕。 ????????? 3 ?????? TIA ?? ??????????300 mg/ d[61，?????? ?????/ ??????????????( 15% ?19% ,RR0. 83 ,95% CI O. 65? 1. 05 ) ，????? ????。 2. ?? : ????????????2006 ?6 ?? 3 ?? 2 ? J Neurol Neurorehabil , June 2006 , Vol.3 ,No. 2 ( 1)????????????? TIA ??? ??????????。 (2)??????????????，???? ????75--- 325 mg/ do ???? 1.??:Ridke: ?[7〕??????????? ?????????????????，39 876 ? ???????(45???)??????100 mg? ???，?? 10 ?，???? :?????????? ???????? 17% (RR 0. 83,95% CI O. 69? 0.99 ;P =0. 04) ，? ????? ??? 24% ( RR 0. 76 , 95% CI 0. 63 ? 0. 93 ;P = 0. 009 ) , TIA ?? 22%a ( RR 0. 78 ,95% CI 0. 64? 0. 94 ;P = 0. 01) ，? ????????????。65 ???????? ????????? ???????????? (??????、??、??????)?26% (RR 0. 74 ,95% CI O. 59?0. 92 ;P =0. 008 ) ，????? ?????34% ( RR 0. 66 ,95% CI 0. 44?0. 97; P =0. 04 ) 。 2 . ?? : ( 1)??????????? ) 45 ????? ???????????????????，?? ?????????????????????。 ( 2 )???????????，?????? ?，???????????(75---150 mg/ d) o 【????】 [ 1 ] The Intern ational Stroke Trial ( IST) : a randomised trial of aspirin, subcutaneous heparin , both，or neither among 19 435 patients with acute ischaemic stroke . Intern ational Stroke Trial Collaborat ive Group[ J ] . Lancet , 1997 , 349 : 1569 ?1581. [ 2 〕CAST; randomised placebo?controlled trial of early aspirin use in 20 000 patients with acute ischaemic stroke. CAST ( Chinese Acute Stroke Trial ) Collaborative Group [ J I . Lancet , 1997，349 : 1641? 16 4 9 . [ 3 ] Antithrombotic Trialists' Collaboration. Collaborative meta?analysis of randomised trials of antiplatelet therapy for prevention of death , myocardial infarction , and stroke in high risk patients [ J ] . BMJ , 2002 ，324 : 71 ?86 . ?4 〕Swedish Aspirin Low-Dose Trial ( SALT) of 75 mg aspirin as sec- ondary prophylaxis after cerebrovascular ischaemic events. The SALT Collaborative Group[ J ] . Lancet , 1991,338 ;1345 ?1349. [ 5 〕European Stroke Prevention Study2. Efficacy and safety data[ J] . J Neurol Sci , 1997 , 151( Suppl) : 1 ?77. [ 6 ] Secondary prevention in non-rheumatic atrial fibrillation after transi- ent ischaemic attack or minor stroke. EAFT ( European Atrial Fibril- lation Trial ) Study Gro up[ J ] . Lancet , 1993，342 : 1255 ?1262. 【7 」Ridker PM, Cook NR , Lee IM，et al. A randomized trial of low? dose aspirin in the primary prevention of cardiovascular disease in women[ J] . N Engl J Med , 2005，352 : 1293 ?1304 . ??????????????????????( ?????? ???) : ??? ? ? ??? ??? ??? ??? ??? ??? ??? ??? ??? ??? ??? ??? ??? ??? ??? ??? ??? ? ? ? ? [????]2006 - 06 - 06