?????????OR????

1
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3
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4
???????????
2004?
2030?
?????? 1 ?????? 1
???? 2 ???? 2
?????? 3 ???????? 3
???????? 4 ?????? 4
??? 5 ???? 5
??? 6 ????????? 6
??? 7 ??? 7
????????? 8 ??????? 8
???? 9 ?? 9
???????? 10 ??? 10
??2008????????, ?????,??????2030???????? ?????????
?
World Health Statistics 2008
5
???????????80
?????? ??????? 80
?????? ??????? 20
Lancet Neurol 2003243-53
6
??????????
??????????
?????19
20
19
20
15?
??????
???()
12
9?
10
10
0
0
7?
1?
???????
??????????
?????
Br J Cardiol. 2002 FEB 9(2)103-105.
7
(No Transcript)
8
????????????????????
?? ??
?? ????
t-PA
9
??????????????????
lt4.5h
lt4.5h
Stroke 2007381655-1711 ESO Guideline Update
January 2009
10
? ?

• ??????????????????????

• ??????????????????????

• ????????????????????

• ?????????
• ????????? OR ????

• ???????????????????

11
?????????????? ????????????
Guideline ASA2007 ESO2008 ACCP-2008
12
?????????????????????????????
BMJ 2000320692-696
13
IST/CAST???? ????????????????????
??/1000 7 4
5 9 2P
lt0.000001 0.05 0.05
0.001
?????()
??????
?????
????
?????
CAST21106???48hrs??????,ASA160mg/d vs Plac.
4Ws IST19435???48hrs??????,ASA300mg/d vs Plac.
14days
Stroke,2000311240-1249
14
?????????????????????????????
??????????????????,??????????????????48 h?????
15
???????????????????
??
??? ???? ???? ????
2002?ASA/AAN?????? ???????????
- - -
- - -
2003?ASA/AHA??????????
- - -
2004?????????
- - -
2005?ASA/AHA??????????
- - -
2007?ASA/AHA??????????
- - -
2008?ACCP8??????
2008?ESO?????????? - -
-
16
(No Transcript)
17
2007?AHA/ASA??????????????????
????????????2448?????????(????325mg)(?,A)
Stroke. 2007381655-1711
18
2007?AHA/ASA?????????? ???????
?????????????????? ?????????(?,C)
19
2007?AHA/ASA?????????? ????????????
??ACS????????????? ????,????????? ??????????????
20
2008?ESO????????????????????

• ??????????48?????????(160325mg????)??(I???,A???)?
  
• ????????????????????????(?????)(III???,C???)?

21
2008?????????????????????(ACCP8)
???????????????????????

• 2008?7?1???
• ???Chest6?supplement
• 90???????????????
• ????900?,???41?
• ??700???????

22
ACCP8 ????????? ????????
??????????????????, ??????????(???? 150325mg)
(?A )
23
ACCP8????????????????????
????????,?????????? ?????????????????? ??????????
???.
24
??????
?? ???????
ASA-2007 325mg
ESO-2008 160-325mg
ACCP-2008 150325mg
????,?????????????????????????????,?????150mg!
25
? ?

• ??????????????????????

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• ?????????
• ????????? OR ????

• ???????????????????

26
??????????????????????

• ??????(?????)
• ??????
• ????????
• ?????(??????)

27
???????????????
28
2008ACCF/ACG/AHA????????????NSAID??????
??NSAID???????(?????) ?????????????????, ????????
??????????????
29
2008ACCF/ACG/AHA???? ???????????????
??????????????? ????????????, ?????????????(PPI)?

ACCF?????????? ACG??????? AHA??????
30
???????????? ????PPI????
8.6
10
????
8
???????()
6
4
2
0.7
????PPI(????)



0
2
4
6
8
10
12
??(?)
Chan FK, et al. N Engl J Med. 2005 Jan 20352(3)238-44.
31
ACCF/ACG/AHA2008?????????????

• ?????????
• ???????????
• ??????????
• ?????????????
• ??????????????
• 60?????
• ????????

32
??????????????????
?????????????????????
60 50 40 30 20 10 0
???????
???? 3304
???? 18574
ASA 100- 325mg 43489
ASA gt325mg 1409
?? GP IIb/IIIa 20529
ASA lt100mg 13337
IV GP IIb/IIIa 22501
???
N33819, 1988-2002??51??????????????
Victor L et al. Am. J. Hematol. 754047, 2004.
33
2002ATC???????????????????
? 1000 ? ? ?
???? /TIA??
???? ??
???? ????
???? ????
BMJ 200232471-86
34
? ?

• ??????????????????????

• ??????????????????????

• ????????????????????

• ????????
• ????????? OR ????

• ???????????????????

35
?????????????????
???
?????
36
???????????????????????
?????????????????????
????? TIA 33-50
gt50
Circulation. 2006113555-563 Stroke 2000
3126417
37
WASID?? the Warfarin-Aspirin Symptomatic
Intracranial Disease
??????????????????????RCT??
Marc I, et al.NEJM,2005,3521368-1370
38
WASID????
????????????

• ????? ?TIA ??6h?

???(INR 2-3)
????? 569? (???????5099)
???
??1.8 ?
????
HR
?????
????
1.04
22.1
22.8
??, ?????, ICH
1.23
20.4
17.0
?????
0.39
3.2
8.3
????
0.46
4.3
9.7
??
HR?????
Chimowitz MI, et al. N Engl J Med, 2005 2521305
39

• ??????????????,??
• ??????????????
• ?????????????????
• ???,??????????????

40
2008?AHA/ASA??????TIA??????
????????????TIA??, ???????????????????, ??????????
????(?,A)
41
??????? ?????????????
?????????????????? ?????????????? ????????????
BMJ 200232471-86
42
? ?

• ??????????????????????

• ??????????????????????

• ????????????????????

• ?????????
• ?????????OR????

• ???????????????????

43
?????/TIA???????????????????????

• ???
• ????????????/TIA??(??????????????????),???????????
  ??????,??????????,????????????(I???,A???)
• ?????/TIA????????????(I ???,A???)
• ???????,????????????(I???,A???)

Reference ??????2009?3??48??3? Chin J Intern
Med, March 2009, Vol. 48. No. 3
44
????????????
45
??????????????????

• ????????????607?????/TIA??

26.9????????? 34.7???????????lt40mg/d

• PRESS-CHINA

???3??-1?????????75.6 (29.794.0)
1.???????????.2006?8?5? 2.PRESS-CHINA???. ??????.
20072(4)301-308
46
?????????????? ??????
????????
??????????
??
47
????????????
9.6
4.0
???????
??????
8.0
???????
42.6
????
????
7.4
???????
??????
??????????
5.3
???????
????
6.5
??
0.6
3.5
3.7
1.8
7.1

• n721
• ????China CARE,????????????

48
(No Transcript)