postpci围手术期抗血小板策略项美香PPT.ppt

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 Spencer B. King III, MD, MACC, FAHA, FSCAI, Co-Chair Sidney C. Smith, MD, FACC, FAHA, Co-Chair John W. Hirshfeld, Jr, MD, FACC, FAHA, FSCAI Alice K. Jacobs, MD, FACC, FAHA, FSCAI Douglass A. Morrison, MD, PhD, FACC, FSCAI David O. Williams, MD, FACC, FAHA, FSCAI 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 I I I IIa IIa IIa IIb IIb IIb III III III I I I IIa IIa IIa IIb IIb IIb III III III I I I IIa IIa IIa IIb IIb IIb III III III IIa IIa IIa IIb IIb IIb III III III I I I IIa IIa IIa IIb IIb IIb III III III I I I IIa IIa IIa IIb IIb IIb