急性冠脉综合征的抗凝治疗新进展PPT.pptVIP

首先这是ACCP指南的推荐：根据低分子肝素最后一次的注射的时间不同可以选择是否再给予抗凝药物。 应该提醒大家的是所有这些都是2C类证据，2C类证据的意思是：利弊比是不明确的，这些证据是来源于观察性研究，不是RCT研究，不是属于推荐的范围，其他替代治疗同样有效。 The task force concluded that substantial evidence exists that patients receiving LMWH for UA/NSTEMI can safely undergo cardiac catheterization and PCI. In addition, they suggested that possible concerns regarding the transition of UA/NSTEMI patients from the medical service to the cardiac catheterization laboratory should not impede the upstream use of LMWH. Finally, they concluded that LMWH and GP IIb/IIIa receptor antagonists can be used safely in combination, with no apparent increase in the risk of major bleedingAn algorithm was formulated to guide procedural anticoagulation in UA/NSTEMI patients who have been treated with LMWH prior to cardiac catheterization. The choice of anticoagulant regimen at the time of intervention is based on the timing of the last subcutaneous LMWH injection, and whether a GP IIb/IIIa antagonist is used. Reference: Kereiakes DJ, Montalescot G, Antman EM, et al. Low-molecular-weight heparin therapy for non-ST-elevation acute coronary syndromes and during percutaneous coronary intervention: An expert consensus. Am Heart J. 2002:In press. 对于STEMI患者行PCI 肝素还是标准治疗。 对于稳定的CAD患者行PCI 低分子肝素在这方面的证据有限。 对于NSTE ACS 患者行PCI 还是首选肝素。 只有在高危的NSTEMI ACS患者介入治疗策略不适用的时候建议用低分子肝素取得普通肝素。是1C类证据。 While the low-molecular-weight heparin (LMWH) enoxaparin (Clexane?/Lovenox?, Aventis Pharma) has been shown to be superior to unfractionated heparin (UFH) in patients with non-ST-segment elevation acute coronary syndromes (NSTE ACS),1,2 its uptake into clinical practice by physicians has been limited, particularly in North America. This failure to use enoxaparin is, in part, related to modern management of NSTE ACS patients, which includes the use of glycoprotein (GP) IIb/IIIa inhibitors and early invasive treatment strategies. The primary aim of this prospective, randomized, open-label, multicentre study involving high-risk NSTE ACS pati