溶栓治疗-东莞市医学会.ppt

体内的监控系统 目前所有抗凝药物都是利用这三个系统 肝素类药物和戊糖都通过ATIII起作用、还有直接Xa和IIa抑制剂。 Permission needed. UFH作为辅助抗凝，2007年更新推荐了已确定疗效的UFH给药方案，其中对于PCI患者的抗凝治疗给出了更为详细的推荐：初始接受UFH治疗者，术中需额外静推UFH，应考虑是否接受了GP IIb/IIIa治疗。比伐卢定可能也可以用于初始接受UFH治疗的患者。此外，为减少HIT发生危险，建议抗凝时间48小时的患者，应选择非UFH抗凝治疗方案。 UFH作为辅助抗凝，2007年更新推荐了已确定疗效的UFH给药方案，其中对于PCI患者的抗凝治疗给出了更为详细的推荐：初始接受UFH治疗者，术中需额外静推UFH，应考虑是否接受了GP IIb/IIIa治疗。比伐卢定可能也可以用于初始接受UFH治疗的患者。此外，为减少HIT发生危险，建议抗凝时间48小时的患者，应选择非UFH抗凝治疗方案。 直接凝血酶抑制剂比伐卢定在2004年的指南中被推荐用于作为替代肝素的链激酶辅助治疗选择，并给出了给药方案，2007年指南更新中增加了比伐卢定在PCI中的应用建议，对于初始接受UFH治疗的患者，可能可以应用比伐卢定。 * * * * * Slide 3 Atherothrombosis: a Generalized and Progressive Process Atherothrombosis is the common underlying disease process for MI, ischemia and vascular death. ACS are classic examples of atherothrombosis (plaque rupture and thrombus formation). ACS (in common with ischemic stroke and critical leg ischemia) are typically caused by rupture or erosion of an atherosclerotic plaque followed by formation of a platelet-rich thrombus. Atherosclerosis is an ongoing process affecting mainly large and medium-sized arteries, which can begin in childhood and progress throughout a person’s lifetime. Stable atherosclerotic plaques may encroach on the lumen of the artery and cause chronic ischemia, resulting in (stable) angina pectoris or intermittent claudication, depending on the vascular bed affected. Unstable atherosclerotic plaques may rupture, leading to the formation of a platelet-rich thrombus that partially or completely occludes the artery and causes acute ischemic symptoms. * Slide 4 Pathophysiology of ACS Various factors affect the risk that an atherosclerotic plaque will rupture, including the tensile strength of the fibrous cap and the shear stresses to which it is subjected. Unstable plaques at high risk of rupture typically have a large lipid core, a thin cap and contain large numbers of macrophages but relatively few smoothmuscle cells. Rupture or fissure of the plaque exposes the thrombogenic core of the lesion and leads to