2012年美国ACCP缺血性卒中抗栓和溶栓治疗指南

Guideline development for this article followed the procedures set forward in the article by Guyatt et al 5 in this supplement. A systematic review of the literature was conducted in November 2009. A systematic approach developed by the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) Working Group was used as the foundation to judge the quality of evidence and to determine the strength of our recommendations. 6 Meta-analyses were performed using RevMan 5.1 (v5.1.1; The Nordic Cochrane Centre, The Cochrane Collaboration, 2011). A random effects model was used for all meta-analyses, with the exception of analyses that included only two studies or analyses that included a single dominant study with a markedly different result from the other studies.

For almost all interventions discussed in this article we included all-cause mortality as a critical outcome. For additional outcomes (eg, stroke, myocardial infarction [MI]), to avoid double counting, we report nonfatal events as opposed to total events. When available, we used observational studies to determine baseline risks (control group risks). When observational data were absent or of low quality, we used data from randomized trials. Patients have varying levels of bleeding risk. The risk of bleeding is increased in patients who have experienced a previous major bleeding event, severe renal failure, concomitant antiplatelet/thrombolytic use, or are . 80 years old. We, do not provide bleeding risk-specific recommendations, however, because validated risk-stratifi cation tools for patients with stroke do not exist. Clinicians and patients need to consider the risk of bleeding when making treatment decisions, specifi cally for interventions for which the recommendation is weak. In situations of uncertain benefi t of a treatment and an appreciable probability of harm, we took a “ primum non nocere ” approach and recommended against such treatment.