醫聲論壇

1.參考用

2.到底過了沒，我也忘記了
　（印象中是沒過，不過好像大原則差不多）

3.回到第一點，僅供參考，被砍不要找我

4.這一個版本的很明確，簡單易懂，不像之前的那麼複雜
　比較大的爭議點是：　
　　　(二)缺血型腦血管疾病病人：
　　　　　1.腦梗塞。
　　　　　2.腦內出血(不含其他顱內出血)。(原給付規定內容，諮詢神經內科專家意見)
　　　　　3.陣發性腦缺血(TIA)。 (諮詢神經內科專家意見)
　　　　　4.有症狀之頸動脈狹窄。(諮詢神經內科專家意見)

之前被廢除的版本

但新的還沒出來...

http://www.realsun.com.tw/new_web/pdf/97n_078.pdf

請問是5/1起適用嗎?

Thanks a lot

打回原形了...

記得這是幾年前已經決議好要採用的新版本,然後被主政者用沒錢當理由一直擱置,
已通過但實施遙遙無期的詭異東西

讚

2012 ESC guideline:
statin class I in non-cardioembolic stroke or TIA
but:

Secondary prevention: Following stroke or TIA, patients are at risk not only of recurrent cerebrovascular events but also of other major CV events including MI. Secondary prevention therapy with statins reduces the risk of stroke, MI, and vascular death. However, the aetiology of stroke may influence the response to statins, and those patients with evidence of atherothrombosis underlying their cerebrovascular events appear to benefit most, while those with haemorrhagic stroke may not benefit or may even be harmed by statins, particularly if patients do not have evidence of atherosclerotic disease. A recent meta-analysis suggests that nicotinic acid alone or in combination with statin may add further benefit in stroke prevention. Table 31 lists the recommendations for lipid-lowering drugs for primary and secondary prevention of stroke.

2010 AHA stroke secondary prevention guideline:
1.tx LDL increase hemorragic stroke(HPS, SPARCL trail).
2.for low HDL, tx with niacin and gembifrozil(in VA-HIT) may be considered.(IIb/B).
3.consider metabolic syn. as a risk factor in secondary prevention.

因此:腦出血不應使用statin!!

讚！