GP IIbIIIa抑制剂在PCI中的应用课件.ppt

GP IIb/IIIa Inhibitors in the PCI Setting Objectives Discuss the pivotal role of platelets in the development of ischemic complications after percutaneous coronary intervention (PCI), including high-risk populations such as patients with diabetes Explore the optimization of PCI outcomes through adequate platelet inhibition achieved through early initiation or in-lab administration Objectives (continued) Address the need to consider and study a more aggressive dosing schedule for reversible glycoprotein (GP) IIb/IIIa inhibitors Discuss the significance of the upcoming, large-scale TENACITY trial, which will test current and emerging clinical practice around combination therapy using GP IIb/IIIa platelet inhibitors Review the safety profile of therapies for PCI GP IIb/IIIa Inhibitors in the PCI Setting Module 1:Early Utilization of GP IIb/IIIa Inhibitors in High-Risk Populations ACS: The Tip of the Atherothrombotic “Iceberg” ACS in the United States Hospital Admissions for ACS: UA/NSTEMI* versus STEMI? The Spectrum of ACS LMWH: Potential Advantages Increased anti-Xa to anti-IIa activity ? inhibits thrombin generation more effectively Dalteparin 2:1, enoxaparin 3.8:1 Less binding to plasma proteins (eg, acute-phase reactant proteins) ? more consistent anticoagulation Lower rate of thrombocytopenia vs unfractionated heparin (UFH) Subcutaneous administration, dosing twice daily No need to monitor its effects UFH or LMWH in UA/NSTEMI LMWH versus UFH in UA/NSTEMI:Effect on Death, MI, Recurrent Ischemia SYNERGY: Major Clinical Endpoints at 30 Days LMWH Limitations Indirect inhibition: dependent on antithrombin Inability to inhibit clot-bound thrombin Catheterization lab: slower onset, longer half-life, and with enoxaparin, no standard test to measure levels/effect CABG: concerns regarding the long half-life Monitoring for Factor Xa: possible, but what is the therapeutic target, increased time, expense? Not all LMWHs are the same CURE: