[Ссылки доступны только зарегистрированным пользователям ]
октябрь 2010
Recommendations
For patients with stroke or TIA due to 50% to 99%
stenosis of a major intracranial artery, aspirin is
recommended in preference to warfarin (Class I;
Level of Evidence B). Patients in the WASID trial
were treated with aspirin 1300 mg/d, but the optimal
dose of aspirin in this population has not been
determined. On the basis of the data on general
safety and efficacy, aspirin doses of 50 mg to 325 mg
of aspirin daily are recommended (Class I; Level of
Evidence B). (New recommendation)
Recommendations
1. For patients with ischemic stroke or TIA with
paroxysmal (intermittent) or permanent AF, anticoagulation
with a vitamin K antagonist (target INR
2.5; range, 2.0 to 3.0) is recommended (Class I; Level
of Evidence A).
2. For patients unable to take oral anticoagulants, aspirin
alone (Class I; Level of Evidence A) is recommended. (не клопи!)
The combination of clopidogrel plus aspirin carries a
risk of bleeding similar to that of warfarin and therefore
is not recommended for patients with a hemorrhagic
contraindication to warfarin (Class III; Level of
Evidence B). (New recommendation)
3. For patients with AF at high risk for stroke (stroke
or TIA within 3 months, CHADS2 score of 5 or 6,
mechanical or rheumatic valve disease) who require
temporary interruption of oral anticoagulation,
bridging therapy with an LMWH administered subcutaneously
is reasonable (Class IIa; Level of Evidence
C). (New recommendation; Table 8)
[Ссылки доступны только зарегистрированным пользователям ]
Aspirin reduces the risk of early recurrent ischemic stroke when given within 48 hours of stroke onset but increases the risk of hemorrhagic stroke (absolute risk reduction = 0.7%; number needed to treat = 143). Overall, for aspirin there is a slight but statistically significant benefit in reducing recurrent stroke. Conversely, unfractionated heparin and LMW heparin/heparinoids, when used within 48 hours of onset in patients with acute ischemic stroke, have not been shown to reduce the rate of stroke recurrence.
Все североамериканские руководства по инсультам (без перевода):
[Ссылки доступны только зарегистрированным пользователям ]
|