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thrombosis and thromboembolism phần 5

Hình 8 Phân tích phân nhóm cho các thiết bị đầu cuối chính của đột quỵ thiếu máu cục bộ, nhồi máu cơ tim, hoặc tử vong mạch máu trong thử nghiệm CAPRIE. Trong số bệnh nhân bị bệnh động mạch ngoại vi, | 138 Creager ị Stroke . _ i--------------------- -------- Mean 95 Cl I Ml ------------ ------------ 1 1 j PAD I --------- ---------- I I ị All patients I I I I I------1------1------1 I I I I I -40 -30 -20 -10 0 10 20 30 40 Aspirin better Clopidogrel better Figure 8 Subgroup analysis for the primary endpoint of ischemic stroke myocardial infarction or vascular death in the CAPRIE trial. Of the patients with peripheral arterial disease those randomized to aspirin had an event rate of 4.86 per year and those randomized to clopidogrel had an event rate of 3.71 per year accounting for relative risk reduction of 23.8 . Reproduced from Ref. 38. eral arterial complications bleeding neutropenia thrombocytopenia or early drug discontinuation because of a noncardiac adverse event. This endpoint occurred in 4.6 of patients in the clopidogrel group compared to 9.1 of those assigned to ticlopidine. The incidence of major adverse cardiac events defined as cardiac death myocardial infarction or target lesion revascularization occurred with a low but similar frequency in each treatment group approximating 1.2 in those who received a clopidogrel loading dose plus maintenance therapy 1.5 of those receiving maintenance clopidogrel without a load and 0.9 of those receiving ticlopidine Fig. 9 . Thus the efficacy of clopidogrel in preventing complications following coronary stenting was comparable to that of ticlopidine yet there were fewer peripheral or bleeding complications with clopidogrel. Given evidence that aspirin or clopidogrel given alone reduces vascular event rates it became critical to evaluate whether the combination of these two agents might provide further benefit for high-risk patients. This issue was addressed in the recently completed Clopidogrel in Unstable angina to prevent Recurrent Events CURE trial which included 12 562 patients with acute coronary Aspirin Ticlopidine and Clopidogrel 139 Figure 9 The CLASSICS trial. The effect of clopidogrel plus aspirin to .