非ST段抬高急性ACS的诊断治疗NSTEACS临床指南解读.pptVIP

The INTERACT study results scheduled for presentation by Shaun Goodman at the scientific late breaking trials session on Monday, 3/19 should further clarify the complimentary role of GP IIb-IIIa Inhibitors and LMWH in the setting of NSTE ACS. Slide 7 The VANQWISH Trial In the VANQWISH study, 920 patients with NQWMI (but not unstable angina) were randomized to an invasive strategy of pre-discharge angiography and revascularization compared with a conservative strategy of intervention alone for recurrent ischemia. Preliminary results showed a higher rate of in-hospital deaths in the early invasive strategy, 4.5% vs. 1.3% in the early conservative strategy. The population in this study, most male, was a moderate to high risk group.3 3. The Vanqwish Trial oral presentation at the ACC meeting Anaheim 199, W.B. Boden personal communication to follow 幻灯片7 在正常状态下，血小板既不会粘附也不会被血管内皮激活。然而，暴露于血流中的损伤内皮或破裂斑块却是致血栓成分，循环中的血小板含有可结合内皮下基质和斑块成分（包括胶原、纤维连接蛋白和von Willebrand 因子等）的受体。在血小板激活过程中，细胞表面的纤维蛋白原受体也被激活，纤维蛋白原可在这些受体间产生多重连接，借此引起血小板的聚集和血栓形成。 Clopidogrel provided a 20% relative risk reduction in the composite outcome of MI, stroke or CV death (95% CI 0.72-0.90, P 0.001). Overall there were 719 (11.4%) first events in the placebo group and 582 (9.3%) in the clopidogrel group. The hazard rate curves began to separate within the first few hours after therapy initiation and continued to diverge over the remainder of the trial. NEJM There was a significant difference in major and minor bleeding between the clopidogrel and aspirin group compared to the aspirin group alone. However, there was no statistically significant difference in life-threatening bleeding between the two treatment arms, which included fatal bleeding, drop in hemoglobin of at least 5 g/dL, significant hypotension requiring IV inotropes, bleeds requiring surgical interventions, intracranial hemorrhage, or transfusion of 4 or more units of blood. Major bleeds were increased both early ( 30 days) and late ( 30 days)