传豆丁心外科围手术期抗凝与凝血课件.pptVIP

目前对于因非心脏手术终止抗凝治疗多长时间较为安全,尚无定论,有学者认为因抗凝过度或非心脏手术需终止抗凝治疗的时间1周左右较为安全,无血栓及栓塞发生 抗凝强度过低,则栓塞的风险增加,尤其盆腔手术,下肢静脉血栓形成的可能性更大 对较大型手术处理稍复杂， 因手术本身会增加静脉血栓发生率， 停用抗凝剂又增加栓塞风险。一般使用肝素替代口服抗凝，使术前6小时机械瓣MVR患者的INR低于2.5，机械瓣AVR患者INR低于2.0,术后6～12小时即恢复使用肝素直至INR大于2.5 一般建议择期手术的患者停服华法林后，可用低分子肝素替代治疗，术前12小时停用。 * 目前的抗血小板药物包括： 血栓素 A2 抑制剂 乙酰水杨酸 (ASA) 磷酸二酯酶抑制剂 潘生丁 糖蛋白(GP) IIb/IIIa阻滞剂 胃肠外用药l: 阿昔单抗、eptifibatide, tirofiban 口服GPIIb/IIIa阻滞剂 (lotrafiban, orbofiban, sibrafiban, xemilofiban) 已经在大规模临床试验中进行了研究，但没能显示疗效优于ASA. ADP-受体拮抗剂 氯吡格雷 噻氯匹定 * 1 Slide 1 Worldwide, the incidence of cardiovascular disease is increasing, especially in developing countries. In one recent report, ischemic heart disease and cerebrovascular disease were the leading causes of death in a survey of eight major world regions: established market economies; formerly socialist economies of Europe; India; China; other Asia and Islands; sub-Saharan Africa; Latin America and the Caribbean; and middle eastern crescent.1 Of the estimated 50,467,000 people worldwide who died in 1990, the leading cause of death was atherothrombosis at 28%. Infectious diseases caused 18% of deaths globally, followed by pulmonary disease at 14%, cancer at 12%, violent deaths at 11%, and AIDS totaling 6%. 1. Murray CJL, Lopez AD. Mortality by cause for eight regions of the world: Global Burden of Disease Study. Lancet 1997;349:1269-1276. * Slide 3 Atherothrombosis: a Generalized and Progressive Process Atherothrombosis is the common underlying disease process for MI, ischemia and vascular death. ACS are classic examples of atherothrombosis (plaque rupture and thrombus formation). ACS (in common with ischemic stroke and critical leg ischemia) are typically caused by rupture or erosion of an atherosclerotic plaque followed by formation of a platelet-rich thrombus. Atherosclerosis is an ongoing process affecting mainly large and medium-sized arteries, which can begin in childhood and progress throughout a person’s lifetime. Stable atherosclerotic plaques