指南与研究新进聂少平

1、血小板破裂血小板破裂血小板黏附血小板黏附血小板激活血小板激活血小板聚集血小板聚集血栓性闭塞血栓性闭塞cilostazole9% (se3) relative riskreduction (2p=0.002)study design1.00.40.60.81.21.6n=1752n=173936%odds reductionoddsevent rates (%)reduction1.00.40.60.81.21.6characteristicodds ratio (95% ci)all interactionsnon-significantdays0510150510152025301.00.4

2、0.60.81.21.6cad patients with qualifying mi (n=3846)pgm= sr25990c/efc4505/csr/us00145/pgm_rpt/i6effkmmi.sas out= output/i6effkmmi.doc (31jan2006 - 17:37) clop placprimary outcome event rate (%)0246810months since randomization 0c: 1903p: 1943 6 1873 189112 1842 185518 1807 181024 1500 148330 996 947

3、 cad patients without qualifying mi (n=1989)pgm= sr25990c/efc4505/csr/us00145/pgm_rpt/i6effkmothcad.sas out= output/i6effkmothcad.doc (31jan2006 - 18:26) clop placprimary outcome event rate (%)0246810months since randomization 0c: 989p: 1000 6 974 98512 956 96918 947 95324 776 80030 435 446 p=0.22no

4、 significancep=0.04borderline significancecad patients with qualifying mi (n=3846)pgm= sr25990c/efc4505/csr/us00145/pgm_rpt/i6effkmmi.sas out= output/i6effkmmi.doc (31jan2006 - 17:37) clop placprimary outcome event rate (%)0246810months since randomization 0c: 1903p: 1943 6 1873 189112 1842 185518 1

5、807 181024 1500 148330 996 947 cad patients without qualifying mi (n=1989)pgm= sr25990c/efc4505/csr/us00145/pgm_rpt/i6effkmothcad.sas out= output/i6effkmothcad.doc (31jan2006 - 18:26) clop placprimary outcome event rate (%)0246810months since randomization 0c: 989p: 1000 6 974 98512 956 96918 947 95

6、324 776 80030 435 446 cvd patients with qualifying is (n=3245)cvd patients with qualifying tia (n=1233)pgm= sr25990c/efc4505/csr/us00145/pgm_rpt/i6effkmis.sas out= output/i6effkmis.doc (31jan2006 - 17:54) clop placprimary outcome event rate (%)02468101214months since randomization 0c: 1634p: 1611 6

7、1583 155712 1548 150918 1513 146424 982 92430 368 376 pgm= sr25990c/efc4505/csr/us00145/pgm_rpt/i6effkmtia.sas out= output/i6effkmtia.doc (31jan2006 - 19:11) clop placprimary outcome event rate (%)0246810months since randomization 0c: 617p: 616 6 599 60612 588 59218 581 58124 365 37930 156 143 与提前与提

8、前6h6h给予负荷量相比，在导管室给予给予负荷量相比，在导管室给予600mg600mg负荷量并无不良影响负荷量并无不良影响尽管提前尽管提前6h6h给予给予600mg600mg负荷量血小板聚集抑制更强，但未见临床得益负荷量血小板聚集抑制更强，但未见临床得益长期服用氯吡格雷的患者长期服用氯吡格雷的患者pcipci前前4-8h4-8h给予给予600mg600mg再负荷并无明确得益再负荷并无明确得益长期服用氯吡格雷的患者不接受再负荷行长期服用氯吡格雷的患者不接受再负荷行pcipci依然安全依然安全di sciascio et al, scai-acci2 2008clopidogrel optimal loading dose usage to reduce recurrent events/optimal antiplatelet strategy for interventionscabg7天内大出血或致命出血天内大出血或致命出血asa and clopidogrel allergy is very important in des implantation decisionsasa desensitization is possible not for anaphylaxisclopidogrel desensitization reportedccu setting for