acs抗凝治疗的指南解析—羊镇宇201207220kppt课件.pptVIP

2011年ESC非ST段抬高ACS诊治指南明确指出：普通肝素勿与依诺肝素交叉使用。 * 2011年ESC非ST段抬高ACS诊治指南： 磺达肝癸钠（2.5mg/日 皮注）在抗凝作用上具有最佳的疗效-安全性。 PCI术前使用磺达肝癸钠患者，PCI手术时应使用普通肝素（85IU/kg，或60IU/kg，联用GP Ⅱb/Ⅲa受体拮抗剂,根据ACT调整；）。 * 皮下注射依诺肝素后4,6,10小时静脉添UFH(70IU/kg)均导致ACT无法探查的过度抗凝 添加UFH后抗Xa水平超过治疗范围 ACT处于治疗范围 Drouet L,et al.Am Heart J.2009 Aug;158(2):177-84. In NSTE-ACS patients pre-treated with enoxaparin,……Crossing over to another anticoagulant during PCI is strongly discouraged—III,B —P26,28 European Heart Journal 2011 Sep 21. [Epub ahead of print] Circulation. 2011;124 2011年ESC非ST段抬高ACS诊治指南 2011ACCF/AHA/SCAI Guideline for PCI Patients treated with SC enoxaparin within 12h of PCI should not receive additional treatment with UFH during PCI—ClassIII:Harm;LOE:B. 普通肝素勿与依诺肝素交叉使用 2011年ESC非ST段抬高ACS诊治指南 推荐 Class Level 磺达肝癸钠（2.5mg/日 s.c.）在抗凝作用上具有最佳的疗效-安全性 Ⅰ A PCI术前使用磺达肝癸钠患者，PCI手术时应使用普通肝素.85IU/kg，或60IU/kg(联用GP Ⅱb/Ⅲa受体拮抗剂),根据ACT调整 Ⅰ B 指南推荐—磺达肝癸钠+UFH European Heart Journal 2011 Sep 21. [Epub ahead of print] Benefit ? thrombotic events Risk bleeding Bivalirudin Fondaparinux Thrombin receptor antagonists (?) ? ? ? A paradigm shift Balancing Risk and Benefit Aspirin ADP antagonist GPIIb/IIIa antagonist Enoxaparin 2011年ESC非ST段抬高ACS诊治指南—抗凝部分 推 荐 Class Level Anticoagulation is recommended for all patients in addition to antiplatelet therapy Ⅰ A The anticoagulation should be selected according to both ischaemic and bleeding risks,and according to the efficacy-safety profile of the chosen agent. I C Fondaparinux（2.5mg s.c.daily）is recommended as having the most favourable efficacy-safety profile with respect to anticoagulation. Ⅰ A If the initial anticoagulant is fondaparinux,a single bolus of UFH(85IU/kg adapted to ACT,or 60IU in the case of concomitant use of GP Ⅱb/Ⅲa receptor inhibitors)should be added at the time of PCI Ⅰ B Enoxaparin（1mg/kg twice daily）is recommended when fondaparinux is not available Ⅰ B In a purely conservative strategy,anticoagulation should be maintained up to hospital discharge I A Discon