post_pci围手术期抗血小板策略_项美香.pptVIP

post-PCI围手术期抗血小板策略 浙江大学医学院附属第二医院 心内科 项美香 ACC/AHA/SCAI Focused Update of the Guideline for Percutaneous Coronary Intervention2007 Writing Committee Members Antiplatelet Therapy A loading dose of clopidogrel, generally 600 mg, should be administered before or when PCI is performed. Modified recommendation In patients undergoing PCI within 12 to 24 hours of receiving fibrinolytic therapy, a clopidogrel oral loading dose of 300mg may be considered. Modified recommendation For all post-PCI stented patients receiving a DES, clopidogrel 75 mg daily should be given for at least 12 months if not at high risk of bleeding. Modified recommendation For patients receiving BMS, clopidogrel should be given for a minimum of 1 month and ideally up to 12 months (unless at increased risk of bleeding). Modified recommendation Antiplatelet Therapy If clopidogrel is given at the time of procedure, supplementation with GP IIb/IIIa receptor antagonists can be beneficial. Modified For patients with an absolute contraindication to aspirin, it is reasonable to give a 300 mg to 600 mg loading dose of clopidogrel, administered at least 6 hours before PCI, and/or GP IIa/IIIa antagonists at the time of PCI. No Change In patients with increased risk of bleeding, a lower dose of 75 mg to 162 mg of aspirin is reasonable during the initial period after stent implantation. New Continuation of clopidogrel therapy beyond 1 year may be considered in patients undergoing DES placement. New Antiplatelet Therapy Patients already taking daily long-term aspirin should take 75 mg to 325 mg before PCI. No changes Patients not already taking daily aspirin should be given 300 mg to 325 mg of aspirin at least 2 hours and preferably 24 hours before PCI. No change After PCI, in patients without allergy or increased risk of bleeding, aspirin 162 mg to 325 mg