Background It remains unclear if intensive antiplatelet and statin treatments begun within 24-72 hours of cerebral ischaemic events from intracranial or extracranial atherosclerosis is effective or safe.Methods The In...Background It remains unclear if intensive antiplatelet and statin treatments begun within 24-72 hours of cerebral ischaemic events from intracranial or extracranial atherosclerosis is effective or safe.Methods The Intensive Statin and Antiplatelet Therapy for High-risk Intracranial or Extracranial Atherosclerosis(INSPIRES)trial is a randomised,double-blind,placebo-controlled,multicentre and 2×2 factorial trial.6100 individuals between the ages of 35 and 80 who have experienced a mild ischaemic stroke or high-risk transient ischaemic attack(TIA)within the previous 72 hours that is attributed to≥50%atherosclerotic stenosis of a major intracranial or extracranial artery or multiple infarctions of atherosclerotic origin will be enrolled in the trial.Eligible subjects will be randomised 1:1:1:1 to one of four groups:(1)intensive antiplatelet therapy(combined clopidogrel and aspirin for days 1-21,then aspirin placebo and clopidogrel for days 22-90)plus immediate intensive statin therapy(atorvastatin at a dose of 80 mg daily for the first 21 days,then 40 mg daily for days 22-90);(2)intensive antiplatelet therapy plus delayed intensive statin therapy(atorvastatin placebo for days 1-3,followed by 40 mg per day of atorvastatin for days 4-90);(3)standard antiplatelet therapy(combination of clopidogrel placebo with aspirin for 90 days)plus immediate intensive statin therapy and(4)standard antiplatelet therapy plus delayed intensive statin therapy.The primary efficacy endpoint is any new stroke(ischaemic or haemorrhagic)within 90 days after randomisation.The primary safety endpoint is moderate to severe bleeding at 90 days.Conclusion The INSPIRES trial will assess the efficacy and safety of intensive antiplatelet therapy and immediate intensive statin therapy begun within 72 hours of onset in decreasing the recurrent stroke at 90 days in patients with acute mild ischaemic stroke or high-risk TIA of intracranial or extracranial atherosclerosis origin.展开更多
Aim Cerebrovascular disease is the leading cause of death and disability in China,causing a huge burden among patients and their families.Hence,stroke prevention is critical,especially in the high-risk population.Here...Aim Cerebrovascular disease is the leading cause of death and disability in China,causing a huge burden among patients and their families.Hence,stroke prevention is critical,especially in the high-risk population.Here,we present the evidence-based guideline suitable for the Chinese population.Methods Literature search of PubMed and Cochrane library(from January 1964 to June 2019)was done.After thorough discussion among the writing group members,recommendations were listed and summarised.This guideline was reviewed and discussed by the fellow writing committees of the Chinese Stroke Association’s Stroke.Results This evidence-based guideline was written in three parts:controlling the risk factors of stroke,utilisation of antiplatelet agents and assessing the risks of first-ever stroke.All recommendations were listed along with the recommending classes and levels of evidence.Conclusions This guideline provides recommendations for primary prevention of cerebrovascular disease among high-risk population in China.Controlling related risk factors,appropriately using antiplatelet agents,assessing the risk of developing first-ever stroke should help reduce the rate of cerebrovascular disease in China.展开更多
基金The study was supported by grants from the National Key R&D Program of China(No.2017YFC1307900,2017YFC1307905)The National Natural Science Foundation of China(No.81825007)+3 种基金Beijing Outstanding Young Scientist Program(No.BJJWZYJH01201910025030)Youth Beijing Scholar Program(No.010)Beijing Talent Project-Class A:Innovation and Development(No.2018A12)'National Ten-Thousand Talent Plan'-Leadership of Scientific and Technological Innovation,Sanofi,and Beijing Jialin Pharmaceutical Co.LTD.
文摘Background It remains unclear if intensive antiplatelet and statin treatments begun within 24-72 hours of cerebral ischaemic events from intracranial or extracranial atherosclerosis is effective or safe.Methods The Intensive Statin and Antiplatelet Therapy for High-risk Intracranial or Extracranial Atherosclerosis(INSPIRES)trial is a randomised,double-blind,placebo-controlled,multicentre and 2×2 factorial trial.6100 individuals between the ages of 35 and 80 who have experienced a mild ischaemic stroke or high-risk transient ischaemic attack(TIA)within the previous 72 hours that is attributed to≥50%atherosclerotic stenosis of a major intracranial or extracranial artery or multiple infarctions of atherosclerotic origin will be enrolled in the trial.Eligible subjects will be randomised 1:1:1:1 to one of four groups:(1)intensive antiplatelet therapy(combined clopidogrel and aspirin for days 1-21,then aspirin placebo and clopidogrel for days 22-90)plus immediate intensive statin therapy(atorvastatin at a dose of 80 mg daily for the first 21 days,then 40 mg daily for days 22-90);(2)intensive antiplatelet therapy plus delayed intensive statin therapy(atorvastatin placebo for days 1-3,followed by 40 mg per day of atorvastatin for days 4-90);(3)standard antiplatelet therapy(combination of clopidogrel placebo with aspirin for 90 days)plus immediate intensive statin therapy and(4)standard antiplatelet therapy plus delayed intensive statin therapy.The primary efficacy endpoint is any new stroke(ischaemic or haemorrhagic)within 90 days after randomisation.The primary safety endpoint is moderate to severe bleeding at 90 days.Conclusion The INSPIRES trial will assess the efficacy and safety of intensive antiplatelet therapy and immediate intensive statin therapy begun within 72 hours of onset in decreasing the recurrent stroke at 90 days in patients with acute mild ischaemic stroke or high-risk TIA of intracranial or extracranial atherosclerosis origin.
文摘Aim Cerebrovascular disease is the leading cause of death and disability in China,causing a huge burden among patients and their families.Hence,stroke prevention is critical,especially in the high-risk population.Here,we present the evidence-based guideline suitable for the Chinese population.Methods Literature search of PubMed and Cochrane library(from January 1964 to June 2019)was done.After thorough discussion among the writing group members,recommendations were listed and summarised.This guideline was reviewed and discussed by the fellow writing committees of the Chinese Stroke Association’s Stroke.Results This evidence-based guideline was written in three parts:controlling the risk factors of stroke,utilisation of antiplatelet agents and assessing the risks of first-ever stroke.All recommendations were listed along with the recommending classes and levels of evidence.Conclusions This guideline provides recommendations for primary prevention of cerebrovascular disease among high-risk population in China.Controlling related risk factors,appropriately using antiplatelet agents,assessing the risk of developing first-ever stroke should help reduce the rate of cerebrovascular disease in China.