CI后抗血小板治疗(TCC).ppt

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%ORAcuteMIAcutestrokePriorMIPriorstroke/TIAOtherhighriskCoronaryarterydisease(unstableangina,heartfailure)Peripheralarterialdisease(intermittentclaudication)22±2%Highriskofembolism(atrialfibrillation)Other(diabetesmellitus)AlltrialsAspirinResistance:MoreThanJustaLaboratoryCuriosity?AspirinResistanceandtheRiskofCardiovacularEventsinHighRiskPatientsVerifyNow™ASA,ASA/clopidogrel(n=464),26.9%ASAresistant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ACOSRegistry-AntiplateletTherapyand1-YearMortalityinST-elevationMISteinhublSR,BergerPB,TiftMannIIIJ,etal.JAMA,November20,2002-Vol288,No19:2411-2420.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DukeRegistry*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.RelationofPlateletInhibitiontoPeriproceduralNecrosisandMACERelationofPlateletInhibitiontoPeriproceduralNecrosisandMACEG.BIONDI-ZOCCAI,SCAI2007ISAR-REACT-2Abciximabinnon-STEACSundergoingPCIpretreatedwith600mgLDclopidogrel00..研究设计四、新型抗血小板药物的研究...JUMBO-TIMI26threedosesofprasugrelvsclopidogrelinelectiveorurgentPCI(safetyevaluation)PRINCIPLETIMI44(PlannedElectivePCI)PRIMARYEPAcutePhase:IPA20uMADPPrasugrel10mgOptimizationofPrasugrelmaintenancedosinginaminorityofpatientsmayhelpimprovethebenefit:riskbalance.2007年ESCNSTE-ACS指南对氯吡格雷的推荐2009年中国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