ASPIRIN (ASA) AND CAROTID ENDARTERECTOMY

来自两个大型临床试验的最新证据已经牢固地确立了 颈动脉内膜剥脱术对症状性高血压患者的益处 颈动脉严重狭窄。目前正在进行的试验将进一步定义 这种外科手术对无症状的患者和 颈动脉中度狭窄。增加的科学研究 对CE进行调查，发现致命性和非致命性减少 中风后的程序，导致了CE的使用增加。 这种情况很可能会持续下去。虽然行政长官带来长期利益，但 也是围术期中风和死亡的直接风险。 因此，至关重要的是，我们必须研究减少这种情况的方法。 风险。 NASCET试验的一项未加控制的观察表明，它可能是 通过简单的治疗方案可降低CE的围手术期风险 由650至1300毫克的每日剂量组成，在服用前开始服用 做手术。尽管ASA在中风预防中的价值已被明确 在过去的十年里建立起来的，在适当的 剂量为一级预防，没有关于剂量的有用信息 对颈动脉手术患者的影响。在 拟议的试验，患者计划在中心接受颈动脉内膜切除术 目前正在参加NASCET协作学习小组的将是 手术前，随机分配给4种药物方案之一，包括 ASA每日剂量为80毫克、325毫克、650毫克或1300毫克，继续服用 已经90天了。这些患者将从手术开始接受为期3个月的随访 记录所有中风、死亡和功能状态的变化。这些 结果将成为比较4种ASA剂量的基础 组。 在美国和加拿大，大约有100,000人接受CE 年。目前，这些患者中约有6%，即6000人患有中风或 在手术后30天内死亡。将这一事件发生率降低50%将 因此，每年有3000人免于中风和死亡，并将 给那些提供和接受它的人更多的信心 外科手术。拟议的审判将确定这种情况是否 好处存在，并提供了评估 使用简单的ASA可能实现的风险降低幅度 治疗方案。

Recent evidence from 2 large clinical trails has firmly established the benefit of carotid endarterectomy (CE) for patients with symptomatic high grade carotid stenosis. Trials currently underway will further define the role of this surgical procedure for asymptomatic patients and for those with more moderate carotid stenosis. The increased scientific investigation of CE, and discovery of a reduction in fatal and non-fatal stroke following the procedure, has led to an increase in the use of CE. This is likely to continue. Although CE produces long term benefits, there is also a substantial immediate perioperative risk of stroke and death. Consequently, it is crucial that we investigate means of reducing this risk. An uncontrolled observation from the NASCET trial suggests that it may be possible to reduce the perioperative risk of CE through a simple regimen consisting of a daily dose of 650 to 1300 mg of ASA started prior to surgery. Although the value of ASA in stroke prevention has been clearly established over the last decade, disagreement exists over the appropriate dose for primary prevention and no useful information exists on dosage effects in patients undergoing surgery to the carotid artery. In the proposed trial, patients scheduled for carotid endarterectomy at centers currently participating in the NASCET collaborative study group, will be randomly assigned, before surgery, to one of 4 drug regimens consisting of ASA at a daily dose of 80 mg, 325 mg, 650 mg, or 1300 mg, to be continued for 90 days. These patients will be followed for 3 months from surgery to record all strokes, deaths and changes in functional status. These outcomes will form the basis for the comparison of the 4 ASA dosage groups. Approximately 100,000 individuals undergo CE in the U.S.A. and Canada each year. Currently about 6%, or 6000, of these patients suffer stroke or death within 30 days of surgery. A 50% reduction in this event rate would thus spare 3000 individuals from stroke and death each year, and would give increased confidence to both those offering and those receiving this surgical procedure. The proposed trial will determine whether such benefits exist and provide the information needed to estimate the magnitude of risk reduction that might be achievable with a simple ASA treatment regimen.