急性冠脉综合征的抗凝抗血小板治疗2011-北京大学第三医院.ppt

ACS的发生机制 为什么需要抗凝抗血小板治疗？ 目前指南的抗凝抗血小板治疗推荐 需要关注的几个重要问题 四、特殊关注的几个问题(Issues-Special Focus) 出血是抗栓治疗的风险，出血增加病死率，增加费用 降低缺血事件和出血风险最低是临床的优先目标 风险积分可以评估院内出血风险 制定特殊的降低出血方案 适当的剂量 经桡动脉途径 轻度：CCr 60~90ml/min 中度：CCr 30~60ml/min 重度：CCr 30ml/min These data prompted the U.S. Food and Drug Administration to issue an advisory in February 2009 regarding the use of prasugrel in the abovementioned patient populations The 2007 ACC/AHA guidelines recommend that, for patients with UA/NSTEMI who will be treated initially according to an invasive strategy, either an intravenous GP IIb/IIIa inhibitor or clopidogrel should be added to aspirin and anticoagulant therapy (upstream) before diagnostic angiography is performed (class I recommendation). They also state that adding both agents is reasonable (class IIa recommendation) Clopidogrel therapy must also be stopped 4 to 7 days before elective coronary artery bypass grafting (CABG), to prevent excessive intraoperative and postoperative bleeding 经皮冠状动脉介入治疗指南： The 2007 ACC/AHA guidelines contain a class IIa recommendation stating that enoxaparin or fondaparinux (see Factor Xa Inhibitors) is preferable to UFH as anticoagulant therapy for UA/NSTEMI patients who will be treated conservatively, unless CABG is planned within 24 hours.42 The benefit of enoxaparin is greater for patients at higher risk, such as those with ST-segment deviation,142 elevated troponin concentrations,143 and high TIMI risk scores. The 2007 ACC/AHA guidelines contain a class IIa recommendation stating that enoxaparin or fondaparinux (see Factor Xa Inhibitors) is preferable to UFH as anticoagulant therapy for UA/NSTEMI patients who will be treated conservatively, unless CABG is planned within 24 hours.42 The benefit of enoxaparin is greater for patients at higher risk, such as those with ST-segment deviation,142 elevated troponin concentrations,143 and high TIMI risk scores. The 2007 ACC/AHA guidelines contain a class IIa recommendation stating that enoxaparin or fondaparinux (s