抗栓治疗概况及展望幻灯片.pptVIP

抗栓治疗概况及展望 中山大学附属第一医院心内科 胡承恒 动脉血栓和静脉血栓 血小板参与启动血栓形成过程 抗血小板治疗 阿司匹林的最小有效剂量 阿司匹林抵抗 ADP受体拮抗剂的适应证扩展 低分子肝素与普通肝素 疗效 清除 用药 剂量 监测 副作用 LMWH ++ 肾脏 皮下 体重 否 少 UFH ++ 内皮/吞噬 静脉 APTT 是 多 Three Categories of Placebo-controlled Trials of GP IIb/IIIa Inhibitors in ACS Decision to proceed with angiography left up to investigator PURSUIT (eptifibatide) Angiography required by study protocol after 48 hours PRISM-PLUS (tirofiban) Early catheterization and PCI (or CABG) prohibited by protocol GUSTO IV (abciximab) PRISM-PLUS: Combined MI/Death Event Reductions at 2, 7, and 30 Days PRISM-PLUS: Combined MI and Death during Initial 48 Hours in All Patients and Post-procedure in Patients Undergoing PTCA Reduction in TnI Levels by Tirofiban in UA/NSTEMI: PRISM-PLUS PRISM-PLUS: Thrombus Grade PRISM-PLUS: TIMI Flow Reversible GP IIb/IIIa in ACS:Death and MI Prior to Catheterization Impact of Early PCI on 30-day Death/MI GUSTO-IV: 30-day Outcomes TACTICS-TIMI 18: Primary Endpoint: Death, MI, Re-hospitalization for ACS at 6 Months ISAR-COOL: Benefit of Early Invasive versus Prolonged Medical Treatment GP IIb/IIIa Inhibitors: Reduction in Death/MI Associated with Time of Administration from Symptom Onset Multiple “Vulnerable” Plaques in Patients with ACS GP IIb/IIIa Inhibitors in the PCI Setting Module 2:Aggressive Dosing Schedules for Reversible GP IIb/IIIa Inhibitors Abciximab Safety: Major Bleeding Events* REPLACE 2: Bleeding Events at 30 Days Abciximab Safety: Results of Phase III Trials—Thrombocytopenia 欣维宁(Triofiban) 非太类血小板糖蛋白Ⅱb/Ⅲa受体可逆性拮抗剂 可抑制ADP诱导的血小板聚集(90%),延长BT 抑制作用与血药浓度相平行,停药后血小板功能恢复基线水平 欣维宁 药代动力学 与血浆蛋白结合率不高,分布广泛 在体内基本无代谢,主要经肾清除,少部分经胆汁清除 血浆半衰期约1.5小时 严重肾功能不全可降低血浆清除率 欣维宁 规格与用法 规格:100 ml(5mg)/瓶 ACS: 30分钟负荷量25-35ml 维持量:6-8ml/h,36小时 PCI: 3分钟负荷量10-15ml