Evidence-Based Evaluation and Selection of Essential Medicine for Township Health Centre in China: 13. Cerebral Circulation Insufficiency_Chinese Journal of Evidence-Based Medicine

Authors：

SHEN Jiantong , LI Xiao ,  LI Youping , YANG Xiaoyan , WANG Li , LI Xianglian , YANG Zongxia , LI Honghao , LI Cuicui , WANG Yingqiang

Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu 610041, China;

Corresponding author：

LI Youping, Email: yzmylab@hotmail.com

Keywords：

Township health center; Essential medicine; Evidence-based evaluation and selection; Cerebral circulation insufficiency

DOI：

10.7507/1672-2531.20120152

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Objective 　To evaluate and select essential medicine for the treatment of cerebral circulation insufficiency by means of evidence-based approaches based on the burden of disease for township health centers located in the eastern, central and western regions of China.
Methods 　By means of the approaches, criteria, and workflow set up in the second article of this series, we referred to the recommendations of evidence-based or authority guidelines from inside and outside China, collected relevant evidence from domestic clinical studies, and recommended essential medicine based on evidence-based evaluation. Data were analyzed by Review Manager (RevMan) 5.1 and GRADE profiler 3.6 to evaluate quality of evidence.
Results 　(1) Five clinical guidelines on transient ischaemic attack/ischaemic stroke were included, all of which were evidence-based clinical guidelines. (2) In total, there were 13 medicines (of five classes) listed in these guidelines. (3) We offer a b recommendation for aspirin as essential medicine for cerebral circulation insufficiency and a weak recommendation for warfarin, clopidogrel, heparin, paracetamol, insulin, normal saline and glucose/dextrose. We made a recommendation against tPA, GPⅡb/Ⅲa and antibiotics according to WHOEML (2011), NEML (2009), CNF (2010), other guidelines and the quantity and quality of evidence. (4) Recommended medicines have been marketed in China and their prices were affordable except Clopidogrel’s. (5) Some results of domestic low-quality studies indicated that recommend medicines were safe and effective, which had significant differences compared to high-quality evidence from foreign studies. Further studies were needed to be confirmed.
Conclusion 　(1) We offer a b recommendation for aspirin and a weak recommendation for warfarin, clopidogrel, heparin, paracetamol, insulin, normal saline and glucose/dextrose. We make a recommendation against tPA, GPⅡb/Ⅲa and antibiotics. (2) There is lack of high-quality evidence from relevant domestic studies, especially on long-term safety and pharmacoeconomic evidence. (3) We propose that more studies should be carried out on the safety, special efficacy and pharmacoeconomic of Chinese medicine, Chinese medicinals and medicine with special efficacy. Besides, we also compare recommended medicine with those of the same class and construct Level 1 to 2 systems of preventing and treating cerebral vascular diseases.

Citation： SHEN Jiantong,LI Xiao,LI Youping,YANG Xiaoyan,WANG Li,LI Xianglian,YANG Zongxia,LI Honghao,LI Cuicui,WANG Yingqiang. Evidence-Based Evaluation and Selection of Essential Medicine for Township Health Centre in China: 13. Cerebral Circulation Insufficiency. Chinese Journal of Evidence-Based Medicine, 2012, 12(8): 967-974. doi: 10.7507/1672-2531.20120152 Copy

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26.	谭江, 李亮, 陈伟星. 氯吡格雷预防脑缺血事件再发的临床观察. 中国热带医学, 2010, 10 (11): 1414-1415.
27.	杨晓云. 氯吡格雷治疗短暂性脑缺血发作临床观察. 中西医结合心脑血管病杂志, 2011, 9(9): 1147.
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40.	周瑞泽. 阿司匹林联合氯吡格雷治疗短暂性脑缺血患者120例. 中国医药指南, 2012, 10(5): 93-94.
41.	孙新帅, 冯青俐. 氯吡格雷联合阿司匹林在T IA 治疗和二级预防中的应用观察. 中国实用神经疾病杂志, 2009, 12(10): 30-32.
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1. 中华医学会神经病学分会脑血管病学组缺血性脑卒中二级预防指南撰写组. 中国缺血性脑卒中和短暂性脑缺血发作二级预防指南2010. 中华神经科杂志, 2010, 43(2): 154-160.
2. 李鸿浩, 王应强, 李幼平, 等. 循证评价与遴选中国东中西部乡院基本药物系列之一: 我国东中西部8家示范乡院2012年住院疾病构成分析. 中国循证医学杂志, 2012, 12(3): 260-266.
3. 李鸿浩, 李幼平, 王莉, 等. 循证评价与遴选中国东中西部乡院基本药物系列之二: 评价标准、方法与流程研究. 中国循证医学杂志, 2012, 12(3): 347-356.
4. AHA/ASA Scientific Statement. Definition and Evaluation of Transient Ischemic Attack. Stroke, 2009, 40: 2276-2293.
5. Lavallée PC, Meseguer E, Abboud H, et al. A transient ischaemic attack clinic with round-the-clock access (SOS-TIA): feasibility and effects. Lancet Neurol, 2007, 6(11): 953-60.
6. Rothwell PM, Giles MF, Chandratheva A, et al. Effect of urgent treatment of transient ischaemic attack and minor stroke on early recurrent stroke (EXPRESS study): a prospective population-based sequential comparison. Lancet, 2007, 370(9596): 1432-1442.
7. 陈捷, 亓树彬. 缺血性脑卒中的流行病学. 实用心脑肺血管病杂志, 2000, 8(3): 179-181.
8. 王忠诚, 程学铭, 李世绰, 等. 中国六城市居民神经系统疾病的流行病学调查. 中华神经外科杂志, 1985, (1): 2-8.
9. 李振三, 杨期东, 苏启庚, 等. 中国农村脑血管病流行病学调查. 中华神经外科杂志, 1989, 5(增刊): 7-11.
10. 王颖, 齐晓飞. 我国各地脑卒中流行病学调查近况. 包头医学, 2010, 34(1): 1-3.
11. 王文志. 中国脑血管病防治研究现状和发展方向. 中国现代神经疾病杂志, 2011, 11(2): 134-137.
12. Furie KL, Kasner SE, Adams RJ, et al. Guidelines for the prevention of stroke in patients with stroke or transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 2011, 42: 227-276.
13. The European Stroke Organization (ESO) Executive Committee and the ESO Writing Committee. Guidelines for Management of Ischaemic Stroke and Transient Ischaemic Attack, 2008.
14. National Collaborating Centre for Chronic Conditions. Stroke: national clinical guideline for diagnosis and initial management of acute stroke and transient ischaemic attack (TIA). London: Royal College of Physicians, 2008.
15. Bryer A, Connor M D, Haug P, et al. South African guideline for management of ischaemic stroke and transient ischaemic attack 2010: A guideline from the South African Stroke Society (SASS) and the SASS Writing Committee. South African Medical Journal, 2010, 100(11): 751-778.
16. 崔友涛. 阿司匹林预防缺血性脑血管病临床研究. 安徽医学, 2005, 26(2): 96-98.
17. 孙吉祥. 奥扎格雷对缺血性卒中患者溶血磷脂酸的影响. 中国医药导报, 2007, 4(14): 64-65.
18. 连佛彦, 石正洪. 低分子肝素对照阿司匹林治疗短暂性脑缺血发作疗效和安全性的Meta分析. 中国医药科学, 2012, 2(5): 19-22.
19. 冯海霞, 杨曼, 蒋怀礼, 等. 西洛他唑与阿司匹林对缺血性脑卒中二级预防的系统评价. 中国康复理论与实践. 2010, 16(10): 961-965.
20. 鄢琦, 石正洪, 杨克虎, 等. 西洛他唑预防缺血性卒中复发疗效和安全性的Meta分析. 中国循证医学杂志, 2011, 11(5): 540-544.
21. 迟国萍. 阿司匹林与氯吡格雷在短暂性脑缺血发作临床防治及推广对照研究. 医学信息, 2011, 24(3): 1213.
22. 黄勇. 氯吡格雷与阿司匹林治疗脑梗死的疗效观察. 中国实用神经疾病杂志, 2009, 12(24): 46-47.
23. 孙新帅, 冯青俐. 氯吡格雷联合阿司匹林在T IA 治疗和二级预防中的应用观察. 中国实用神经疾病杂志, 2009, 12(10): 30-32.
24. 罗伟良, 徐剑斌, 黄林辉, 等. 华法林负荷量法抗凝治疗短暂性脑缺血发作的研究. 中国临床药理学与治疗学. 2004, 9(6): 705-708.
25. 陈光, 马春潮. 氯吡格雷预防脑缺血事件复发的疗效. 国外医学脑血管疾病分册, 2005, 13(11): 815-816.
26. 谭江, 李亮, 陈伟星. 氯吡格雷预防脑缺血事件再发的临床观察. 中国热带医学, 2010, 10 (11): 1414-1415.
27. 杨晓云. 氯吡格雷治疗短暂性脑缺血发作临床观察. 中西医结合心脑血管病杂志, 2011, 9(9): 1147.
28. 贺昕, 王颖. 氯吡格雷治疗短暂性脑缺血发作的效果评价. 现代预防医学, 2011, 37(114): 2782-2783.
29. Chen ZM, Sandercock P, Pan HC, et al. Indications for early aspirin use in acute ischemic stroke: A combined analysis of 40 000 randomized patients from the Chinese acute stroke trial and the international stroke trial. On behalf of the CAST and IST collaborative groups. Stroke, 2000, 31(6): 1240-1249.
30. Antithrombotic Trialists’ Collaboration. Collaborative meta-analysis of randomized trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. BMJ, 2002, 324(7329): 71-86.
31. Taylor DW, Barnett HJ, Haynes RB, et al. Low-dose and high-dose acetylsalicylic acid for patients undergoing carotid endarterectomy: a randomized controlled trial. ASA and Carotid Endarterectomy (ACE) Trial Collaborators. Lancet, 1999, 353(9171): 2179-2184.
32. Sandercock PA, Counsell C, Gubitz GJ, et al. Antiplatelet therapy for acute ischaemic stroke. Cochrane Database Syst Rev, 2008, (3): CD000029.
33. Slattery J, Warlow CP, Shorrock CJ, et al. Risks of gastrointestinal bleeding during secondary prevention of vascular events with aspirin--analysis of gastrointestinal bleeding during the UK-TIA trial. Gut, 1995, 37(4): 509-511.
34. Derry S, Loke YK. Risk of gastrointestinal haemorrhage with long-term use of aspirin: meta-analysis. BMJ, 2000, 321: 1183.
35. Hankey GJ, Sudlow CL, Dunbabin DW. Thienopyridine derivatives (ticlopidine, clopidogrel) versus aspirin for preventing stroke and other serious vascular events in high vascular risk patients. Cochrane Database Syst Rev, 2000, (2): CD001246.
36. Diener HC, Bogousslavsky J, Brass LM, et al. Aspirin and clopidogrel compared with clopidogrel alone after recent ischaemic stroke or transient ischaemic attack in high-risk patients (MATCH): randomised, double-blind, placebo-controlled trial. Lancet, 2004, 364(9431): 331-337.
37. 陈少媚, 李勇. 谢坚. 阿司匹林联合氯吡格雷对阿司匹林抵抗患者预防缺血性脑卒中的疗效评价. 中国现代医药杂志, 2010, 12 (7): 66-68.
38. 李培育, 左寒璐, 王复新, 等. 阿司匹林联合氯吡格雷治疗短暂性脑缺血发作38例临床分析. 中国医药科学, 2011, 1(17): 94.
39. 许风雷, 李翠萍, 热依汗, 等. 阿司匹林联合氯吡格雷治疗短暂性脑缺血发作疗效观察. 中国实用神经疾病杂志, 2010, 13(1): 32-33.
40. 周瑞泽. 阿司匹林联合氯吡格雷治疗短暂性脑缺血患者120例. 中国医药指南, 2012, 10(5): 93-94.
41. 孙新帅, 冯青俐. 氯吡格雷联合阿司匹林在T IA 治疗和二级预防中的应用观察. 中国实用神经疾病杂志, 2009, 12(10): 30-32.
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Chinese Journal of Evidence-Based Medicine

Evidence-Based Evaluation and Selection of Essential Medicine for Township Health Centre in China: 13. Cerebral Circulation Insufficiency

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