急性冠脉综合征患者接受经皮冠状动脉介入治疗前后抗凝策略

摘要/Abstract

摘要： 急性冠脉综合征(ACS)是一组由急性心肌缺血引起的临床综合征,包括不稳定型心绞痛(UA)、非ST段抬高型心肌梗死(NSTEMI)和ST段抬高型心肌梗死(STEMI)。目前抗血小板治疗和抗凝治疗是ACS患者抗栓治疗的两大重要组成部分。强力抗血小板及抗凝药物的出现,在很大程度上减少了ACS患者缺血事件的发生率,但经皮冠状动脉介入治疗(PCI)围手术期抗血小板及抗凝治疗的联合应用增加了出血风险,而出血风险又增加发生死亡、心肌梗死(MI)或卒中的风险,其原因可能与输血和/或停用抗凝抗血小板药物有关。因此,权衡抗栓效应及出血风险可进一步改善ACS患者临床疗效。本文就ACS患者有关接受PCI前后的抗凝治疗策略的一些大型临床试验及抗凝药物在当今早期侵入性冠状动脉治疗时代中的应用现状作一综述。

关键词: 急性冠脉综合征, 经皮冠状动脉介入治疗, 抗凝治疗

Abstract: Acute coronary syndrome (ACS) is a clinical syndrome caused by acute cardiac ischemia,including unstable angina (UA) ,non-ST-segment elevation myocardial infarction (NSTEMI) and ST-segment elevation myocardial infarction (STEMI).Currently antiplatelet and antithrombin therapies become the two important components of the antithrombotic treatment of patients with ACS.The advent of potent antiplatelet and antithrombin agents has resulted in significant improvement in reducing ischemic events in patients with ACS. However,the combination of antiplatelet and antithrombotic therapy during the PCI periprocedural period,has led to an increase in the risk of bleeding. More importantly,such complications have been reported to be associated with an increased risks of mortality,myocardial infarction,and stroke. Possible mechanisms include bleeding-induced imbalance of the coagulant/anticoagulant, adverse effects induced by transfusion, and cessation of antithrombotic/anticoagulant therapy. So the balance between antithrombotic effect and risk of bleeding may further improve clinical outcomes of patients with ACS. In this article we present an overview on clinical trials evaluating the different aspects of antithrombotic therapy in patients undergoing PCI and discuss the emerging role of these agents in the contemporary era of early invasive coronary intervention.

Key words: Acute coronary syndrome, Percutaneous coronary intervention, Antithrombotic therapy

中图分类号:

贾亮亮, 柯永胜. 急性冠脉综合征患者接受经皮冠状动脉介入治疗前后抗凝策略[J]. 中国临床药理学与治疗学, 2013, 18(4): 469-475.

JIA Liang-liang, KE Yong-sheng. Anticoagulation strategies in patients undergoing percutaneous coronary intervention for acute coronary syndrome[J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2013, 18(4): 469-475.

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