赛诺菲stemi抗凝新进展完整版.pptVIP

2012年ESC指南  2012STEMI指南 * 克赛 磺达肝癸钠 比伐卢定 直接PCI IIbB III（不推荐） IB 溶栓治疗 I A IIa B（应用链激酶溶栓的患者） -- 保守治疗 尽早使用 尽早使用 -- This slide shows use of enoxaparin vs UFH as adjunctive anticoagulation therapy to fibrinolysis as per the ExTRACT – TIMI 25 protocol. The hypothesis was: compared to UFH, adjunctive antithrombin therapy with ENOX reduces the composite end point of all-cause mortality or non-fatal reMI within 30 days in patients with STEMI who are eligible to receive fibrinolytic therapy. 这是主要终点的结果：30天时，与普通肝素组相比，依诺肝素组主要终点绝对RR下降2.1个百分点，RRR下降17％，显示有统计学显著差异；需要特别提出的是，只有3例患者失访，这提示该试验的质量较高。 正如前面所述，两个试验组的用药时间有一定差异——因此，整个随访时间内两组进行比较就显得非常重要：可以看到，48小时时，两组进行直接比较时已经显示依诺肝素组更优，只是还没有显示有统计学显著差异。 第8天时，依诺肝素组在主要终点方面已经显示显著优于普通肝素组。 所以，可以概括来说，48小时时依诺肝素组已经有10％的RRR，30天时，RRR可达到17％，且显示有统计学显著差异。 The PCI ExTRACT study is a subgroup analysis of patients enrolled in the ExTRACT-TIMI 25 trial. Reminder: The Enoxaparin and Thrombolysis Reperfusion for Acute MI Treatment (ExTRACT-TIMI 25) study compared a strategy of enoxaparin (ENOX) with unfractionated heparin (普通肝素) as adjunctive therapy for fibrinolysis among STEMI patients1 Antman EM et al. Enoxaparin vs 普通肝素 with fibrinolysis for ST-elevation myocardial infaction. N Engl J Med 2006;354:1477-88. Abreviation ASA – acetylsalicylic acid (aspirin) ACEI – angiotensin converting enzyme inhibitor ARB – angiotensin II receptor blocker CABG – coronary artery bypass graft CI – confidence interval CrCl - creatinine clearance ENOX – enoxaparin ExTRACT - Enoxaparin and Thrombolysis Reperfusion for Acute Myocardial Infarction Treatment GP – glycoprotein Hx – history ICH - intracranial hemorrhage ITT – intention to treat IV - intravenous MI – myocardial infarction ORadj – odds ratio adjusted PCI - percutaneous coronary intervention RR - relative risk RRR – relative risk reduction rPA - reteplase SC – subcutaneous SK - streptokinase STEMI - ST-elevation myocardial infarction TIMI - Thrombolysis in Myocardial Infarction TNK - tenecteplase TPA - tiss