Background: Oral anticoagulation therapy reduces risk of vascular events in patients with atrial fibrillation. However, long-term monitoring is necessary and many patients cannot achieve optimum anticoagulation. We as...Background: Oral anticoagulation therapy reduces risk of vascular events in patients with atrial fibrillation. However, long-term monitoring is necessary and many patients cannot achieve optimum anticoagulation. We assessed whether clopidogrel plus aspirin was non-inferior to oral anticoagulation therapy for prevention of vascular events. Methods: Patients were enrolled if they had atrial fibrillation plus one or more risk factor for stroke, and were randomly allocated to receive oral anticoagulation therapy(target international normalised ratio of 2.0-3.0; n=3371) or clopidogrel(75 mg per day) plus aspirin(75-100 mg per day recommended; n=3335). Outcome events were adjudicated by a blinded committee. Primary outcome was first occurrence of stroke, non-CNS systemic embolus, myocardial infarction, or vascular death. Analyses were by intention-to-treat. This study is registered with ClinicalTrials.gov, number NCT00243178. Results: The study was stopped early because of clear evidence of superiority of oral anticoagulation therapy. There were 165 primary events in patients on oral anticoagulation therapy(annual risk 3.93%) and 234 in those on clopidogrel plus aspirin(annual risk 5.60%; relative risk 1.44(1.18-1.76); p=0.0003). Patients on oral anticoagulation therapy who were already receiving this treatment at study entry had a trend towards a greater reduction in vascular events(relative risk 1.50, 95%CI 1.19-1.89) and a significantly(p=0.03 for interaction) lower risk of major bleeding with oral anticoagulation therapy(1.30; 0.94-1.79) than patients not on this treatment at study entry(1.27, 0.85-1.89 and 0.59, 0.32-1.08, respectively). Conclusion: Oral anticoagulation therapy is superior to clopidogrel plus aspirin for prevention of vascular events in patients with atrial fibrillation at high risk of stroke, especially in those already taking oral anticoagulation therapy.展开更多
目的探讨多学科协作模式在初发脑卒中患者康复治疗中的应用。方法选取我院88例初发脑卒中患者作为研究对象。采用数字随机法,将其分为研究组和对照组,每组各44例。对照组采用常规康复治疗,研究组通过多学科协作模式进行康复治疗,对比两...目的探讨多学科协作模式在初发脑卒中患者康复治疗中的应用。方法选取我院88例初发脑卒中患者作为研究对象。采用数字随机法,将其分为研究组和对照组,每组各44例。对照组采用常规康复治疗,研究组通过多学科协作模式进行康复治疗,对比两组患者临床疗效。结果治疗前,两组National Institute of Health Stroke Scale(NIHSS)评分、Activity of Daily Living(ADL)评分以及Fugl-Meyer Assessment Scale(FMA)评分对比,差异不具有统计学意义(P>0.05);治疗后,两组NIHSS评分、总并发症发生率均低于治疗前,且研究组低于对照组;两组ADL评分、FMA评分均高于治疗前,且研究组高于对照组,差异均具有统计学意义(P<0.05)。结论多学科协作模式在脑卒中患者康复治疗中具有良好的效果,能有效促进神经功能的恢复,提高患者生活质量。展开更多
文摘Background: Oral anticoagulation therapy reduces risk of vascular events in patients with atrial fibrillation. However, long-term monitoring is necessary and many patients cannot achieve optimum anticoagulation. We assessed whether clopidogrel plus aspirin was non-inferior to oral anticoagulation therapy for prevention of vascular events. Methods: Patients were enrolled if they had atrial fibrillation plus one or more risk factor for stroke, and were randomly allocated to receive oral anticoagulation therapy(target international normalised ratio of 2.0-3.0; n=3371) or clopidogrel(75 mg per day) plus aspirin(75-100 mg per day recommended; n=3335). Outcome events were adjudicated by a blinded committee. Primary outcome was first occurrence of stroke, non-CNS systemic embolus, myocardial infarction, or vascular death. Analyses were by intention-to-treat. This study is registered with ClinicalTrials.gov, number NCT00243178. Results: The study was stopped early because of clear evidence of superiority of oral anticoagulation therapy. There were 165 primary events in patients on oral anticoagulation therapy(annual risk 3.93%) and 234 in those on clopidogrel plus aspirin(annual risk 5.60%; relative risk 1.44(1.18-1.76); p=0.0003). Patients on oral anticoagulation therapy who were already receiving this treatment at study entry had a trend towards a greater reduction in vascular events(relative risk 1.50, 95%CI 1.19-1.89) and a significantly(p=0.03 for interaction) lower risk of major bleeding with oral anticoagulation therapy(1.30; 0.94-1.79) than patients not on this treatment at study entry(1.27, 0.85-1.89 and 0.59, 0.32-1.08, respectively). Conclusion: Oral anticoagulation therapy is superior to clopidogrel plus aspirin for prevention of vascular events in patients with atrial fibrillation at high risk of stroke, especially in those already taking oral anticoagulation therapy.
文摘目的探讨多学科协作模式在初发脑卒中患者康复治疗中的应用。方法选取我院88例初发脑卒中患者作为研究对象。采用数字随机法,将其分为研究组和对照组,每组各44例。对照组采用常规康复治疗,研究组通过多学科协作模式进行康复治疗,对比两组患者临床疗效。结果治疗前,两组National Institute of Health Stroke Scale(NIHSS)评分、Activity of Daily Living(ADL)评分以及Fugl-Meyer Assessment Scale(FMA)评分对比,差异不具有统计学意义(P>0.05);治疗后,两组NIHSS评分、总并发症发生率均低于治疗前,且研究组低于对照组;两组ADL评分、FMA评分均高于治疗前,且研究组高于对照组,差异均具有统计学意义(P<0.05)。结论多学科协作模式在脑卒中患者康复治疗中具有良好的效果,能有效促进神经功能的恢复,提高患者生活质量。
