氯吡格雷(波立维)在急性冠脉综合征治疗中的地位.pptVIP

治疗：新概念 抗栓治疗 -- 溶栓治疗 -- PCI治疗 -- 抗凝治疗 -- 抗血小板治疗 -- 稳定斑块治疗 ACS 抗栓治疗的进展 1. 处理已形成的血栓 开通闭塞的罪犯血管 恢复冠脉灌注 溶栓治疗 PCI 治疗 2. 防止新的血栓形成 防止血栓扩展 缩小损伤范围 抗凝治疗 抗血小板治疗 1. 处理已形成的血栓 目的：开通闭塞的罪犯血管、恢复冠脉灌注 STEMI – 溶栓 / 直接PCI NSTEMI – 早期介入策略 2. 防止新的血栓形成 目的：防止血栓扩展、缩小损伤范围 抗凝治疗—UFH / LMWH 抗血小板治疗—ASA / Clopidogrel / GP IIb/IIIa 血小板是病理血栓形成的最重要罪犯因子 血小板活化、聚集在血栓形成过程中发挥极关键的作用。 血小板聚集的致聚剂 ADP是体内重要的血小板激活剂 ADP分为外源性ADP和内源性ADP 凝血酶、胶原、血栓素A2等诱发的血小板 聚集均与血小板内源性ADP密切相关 通过血小板ADP受体聚集的机制 ADP是引起血小板聚集的最重要诱导剂 研究：氯吡格雷(波立维)预处理给STEMI患者带来更多益处 高负荷剂量600mg明显降低主要终点事件率 ARMYDA-2 Trial Meta分析结果显示 高负荷剂量的临床效果更好 CURE试验中停止服用试验药物（退出研究）的患者分析停用氯吡格雷后原有的临床获益逐渐消失 CABG 术前5天停用氯吡格雷，可有效避免大出血 谢 谢! * Slide 13 PCI-CURE – Safety Bleeding complications There was a non-significant and small excess in major, but not life-threatening bleeding in the group treated with clopidogrel on top of standard therapy (including ASA). The major bleeding rates were 1.6% vs. 1.4% at 30 days and 2.7% vs. 2.5% at the end of follow-up [clopidogrel on top of standard therapy (including ASA) vs. standard therapy (including ASA) alone]. Although the major bleeding rates from PCI to 30 days might be expected to be similar due to open label ADP-receptor antagonist use, this would not be the case from 30 days to the end of the trial. Minor bleeding increased in the group receiving clopidogrel on top of standard therapy (including ASA) from 2.1% to 3.5% (p=0.03) from PCI to end of follow-up. Concomitant use of an intravenous GP IIb/IIIa antagonist bleeding rates were identical between the clopidogrel and placebo treated groups (major bleeding, 2.2% vs. 2.2%; life-threatening bleeding, 1.1% vs. 1.1%) this suggests that pretreatment with clopidogrel does not incrementally increase the risk of ble