袁晋青pci后抗血小板治疗tcc课件.pptVIP

介入术后抗血小板治疗;一．抗血小板药物作用机制和阿司匹林抵抗;不同的抗血小板药物作用机制 ;Category % OR Acute MI Acute stroke Prior MI Prior stroke/TIA Other high risk Coronary artery disease(unstable angina, heart failure) Peripheral arterial disease(intermittent claudication) 22 ± 2 % High risk of embolism (atrial fibrillation) Other (diabetes mellitus) All trials ;Aspirin Resistance: More Than Just a Laboratory Curiosity?;Aspirin Resistance and the Risk ofCardiovacular Events in High Risk Patients;VerifyNow?ASA, ASA/clopidogrel (n=464), 26.9% ASA resistant;二、氯吡格雷的早期和长期应用 　　 　　　－什么时间用？用多长时间？;CLARITY 急救亚组研究: 住院前氯吡格雷对比安慰剂(加溶栓治疗);试验 ;;氯吡格雷预处理对PCI显著有益;;氯吡格雷可降低NSTEMI患者1年严重心脑血管不良事件发生率;ACOS Registry-Antiplatelet Therapy and 1-Year Mortality in ST-elevation MI;Steinhubl SR, Berger PB, Tift Mann III J, et al. JAMA, November 20, 2002-Vol 288, No 19: 2411-2420.;荟萃分析表明： DES与BMS相比，迟发性血栓有升高的趋势;迟发性支架内血栓;停用氯吡格雷后患者心源性死亡／心梗的发生率明显升高且大多数事件由血栓引起;Eisenstein, JAMA. 2007;297:(doi:10.1001/jama.297.2.joc60179);DES术后氯吡格雷治疗长期疗效 Duke Registry*;无论置入何种支架，氯吡格雷应用越久，获益越多;未来－双联抗血小板治疗更长的疗程？;开放DAPT治疗;三、氯吡格雷负荷量及相关问题 　　　 　　－用什么样的剂量及三联抗血小板;Relation of Platelet Inhibition to Periprocedural Necrosis and MACE ;Relation of Platelet Inhibition to Periprocedural Necrosis and MACE ;;;;;;G. BIONDI-ZOCCAI, SCAI 2007;ISAR-REACT-2Abciximab in non-STE ACS undergoing PCI pretreated with 600mg LD clopidogrel;;0;0;研究设计;四、新型抗血小板药物的研究;JUMBO-TIMI 26 three doses of prasugrel vs clopidogrel in elective or urgent PCI (safety evaluation);PRINCIPLE TIMI 44 (Planned Elective PCI) PRIMARY EP Acute Phase: IPA 20 uM ADP;Prasugrel 10 mg;;;;Optimization of Prasugrel maintenance dosing in a minority of patients may help improve the benefit: risk balance;2007年ESC NSTE-ACS指南对氯吡格雷的推荐;2009年中??PCI治疗指南 阿司匹林推荐;2009年中国PCI治疗指南 氯吡格雷PCI术前推荐;2009年中国PCI治疗指南 氯吡格雷PCI术后推荐;谢谢