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,Click to edit Master title style,Click to edit Master title style,Click to edit Master title style,Click to edit Master title style,Click to edit Master title style,Click to edit Master title style,Click to edit Master title style,*,Click to edit Master title style,*,*,Click to edit Master title style,*,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,Proposals subject to consultation,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,Click to edit Master title style,Click to edit Master text styles,Second 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style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,STICKER,Legend,Legend,Legend,Legend,Legend,Legend,Legend,Legend,Legend,Legend,Legend,Legend,*,CONFIDENTIAL,Document,Date,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,Proposals subject to consultation,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,NSTE ACS,抗凝治疗策略,无锡人民医院 心脏中心,羊镇宇,NSTE ACS抗凝治疗策略无锡人民医院 心脏中心,NSTE ACS,治疗的重要环节,血运重建,抗缺血治疗,抗血小板治疗,抗凝治疗,长期管理,Eur Heart J.2007,28:15981660,ESC,指南抗凝治疗推荐,所有,NSTE-ACS,患者均应接受抗凝治疗（,I-A,）,NSTE ACS治疗的重要环节血运重建抗缺血治疗抗血小板治疗,2011 ESC,AHA,指南,(,NSTE-ACS,抗凝相关,),患者接受抗血小板治疗的同时应接受抗凝治疗,抗凝药物的选择要兼顾疗效和安全性,新增拟行紧急侵入治疗患者的抗凝治疗建议,其他：,不推荐交叉应用普通肝素和,LMWH,2011 ESC,AHA 指南(NSTE-ACS抗凝相关)患,内皮损伤诱发血栓形成示意图,凝血酶是血管损伤、凝血及血小板激活的纽带,胶原,组织,因子,凝血酶,IIa,血小板,激活,凝血酶原,II,ADP,TXA,2,凝血,瀑布,血栓,纤维蛋白原,纤维蛋白,血小板,聚集,凝血酶是凝血过程中的重要介质，可催化纤维蛋白及诱发血小板聚集,Pollack,CV,et al.,The Journal of Emergency Medicine,.,2008,(,34,),4,:,417,-,428,内皮损伤诱发血栓形成示意图凝血酶是血管损伤、凝血及血小板激活,AMI,闭塞性血栓的构成以混合性血栓为主,91,例透壁心肌梗死患者的尸解资料,血小板血栓,15%(14,of 91),以血小板为主的混合血栓 5%,(4,of 91),以纤维蛋白和红细胞为主的混合血栓 80%(73,of 91),K.Peter Rentrop,MD Thrombi in Acute Coronary Syndromes Revisited and Revised,Circulation.,2000;101:1619.),Sinapius D.Zur Morphologie verschliessender Koronarthromben.,Dtsch Med Wochenschr.,1972;97:544551.,这提示抗凝治疗与抗血小板治疗同等重要,AMI闭塞性血栓的构成以混合性血栓为主91例透壁心肌梗死患者,UA/NQMI,患者，强化抗血小板治疗并不能改变凝血活跃的状态,For the Clopidogrel in Unstable angina to prevent Recurrent Events(CURE)Study Investigators,European Heart Journal,(2002)23,1771-779,UA/NQMI患者，强化抗血小板治疗并不能改变凝血活跃的状态,Oldgren,J.et al.Arterioscler Thromb Vasc Biol 2001;21:1059-1064,Probability of death during long-term follow-up:median,29 months;minimum,12 months;and maximum,50 months in relation to baseline(pretreatment)levels of the respective coagulation marker,凝血指标与远期预后的关系,死,亡,可,能,性,Oldgren,J.et al.Arterioscle,法国一项针对急性心肌梗塞患者,PCI,术前使用抗凝药物的研究,Francois Schiele,et al.Circulation.2009;120:S951-S952.,spo.escardio.org/eslides/view,-ESC2009,未抗凝组,&UFH,组,根据,ACT,调整,UFH,用量,.,患者使用,enoxaparin 8h,PCI,术中依诺肝素,0.3mg/kg,患者使用磺达肝癸钠,PCI,术中,UFH50U/kg,法国一项针对急性心肌梗塞患者PCI术前使用抗凝药物的研究F,PCI,术前使用抗凝药物,STEMI,，,NSTMI,两类患者均有获益,PCI术前使用抗凝药物STEMI，NSTMI两类患者均有获,凝血系统激活有利于血栓的扩大和持续存在,凝血系统激活有利于血栓的扩大和持续存在,2011,年,ESC,非,ST,段抬高,ACS,诊治指南,所有患者在接受抗血小板治疗的同时应接受抗凝治疗,Anticoagulation is effective in addition to platelet inhibition and that the combination of the two is more effective than either treatment alone-P23,European Heart Journal 2011 Sep 21.Epu
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