房颤患者发生ACS或植入冠脉支架时抗栓治疗的共识
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文章浏览→编程相关Access→房颤患者发生ACS或植入冠脉支架时抗栓治疗的共识

房颤患者发生ACS或植入冠脉支架时抗栓治疗的共识
房颤患者发生ACS或植入冠脉支架时抗栓治疗的共识

Title: AntithromboticManagement of Atrial Fibrillation Patients Presenting with AcuteCoronary Syndrome and/or Undergoing Coronary Stenting: ExecutiveSummary-A Consensus Document of the European Society ofCardiology Working Group on Thrombosis, Endorsed by theEuropean Heart Rhythm Association (EHRA) and the EuropeanAssociation of Percutaneous Cardiovascular Interventions(EAPCI)房颤(AF)患者发生急性冠脉综合征(ACS)或植入冠脉支架时抗栓治疗的共识
Topic: InterventionalCardiology
Date Posted: 5/12/2010
Author(s): Lip GY, Huber K,Andreotti F, et al.
Citation: Eur Heart J 2010;May 6:[Epub ahead ofprint].

 

Perspective: The following are 10points to remember from this consensus document:
共识文件总结需要记住的以下10点
1. Approximately 70-80% of patients with atrial fibrillation (AF)have an indication for oral anticoagulation therapy (OAT). Coronaryartery disease co-exists in 20-30% of these patients.
大约70%-80%的AF患者有口服抗凝药治疗(OAT)的适应症。这些AF患者有20-30%同时患有冠心病。
2. Patients with AF on OAT are oftenbridged with unfractionated heparin or low molecular weight heparinif they need coronary angiography or percutaneous coronaryintervention (PCI). Use of bridging therapy is associated withincreased risk of access site complications in some studies. Someobservational studies suggest that coronary angiography or PCI canbe safely performed without interrupting OAT, and may be associatedwith a lower rate of complications compared with bridgingtherapy.
AFOAT患者如果需要做冠脉造影(CAG)或PCI,常常临时过渡改为普通肝素(UFH)或低分子肝素(LMWH)治疗。一些研究显示这样伴随血管穿刺部位并发症风险增加。一些观察性研究提示不中断OAT治疗,CAG或PCI也可安全进行,与临时过渡治疗相比,可能并发症的发生率更低。

3. In small series, the rate of complications in patients on OATwho undergo angiography or PCI via the femoral route has been low.However, the radial route should be preferred in patients onOAT.
一些小系列研究,OAT患者经股动脉途径CAG或PCI并发症发生率低,但是OAT患者应该优先选用桡动脉途径。

4. There is no need for additional heparin in patients who undergoPCI while therapeutic on OAT (international normalized ratio [INR]2-3).
OAT治疗的患者(INR2-3)PCI时没有必要额外增加肝素治疗。

5. Aspirin and clopidogrel should be administered prior to theprocedure when PCI is performed in a patient on OAT.
OAT患者PCI前应使用阿司匹林和氯吡格雷。

6. The use of platelet glycoprotein IIb/IIIa inhibitors increasesthe risk of bleeding in patients on OAT 3- to 13-fold and theroutine use of these agents should be avoided in patients onOAT.
GPIIb/IIIa抑制剂增加OAT患者出血风险,增加3-13倍。OAT患者应该避免常规使用GPIIb/IIIa 抑制剂。

7. Use of aspirin and warfarin does not provide sufficientprotection against risk of stent thrombosis. Patients undergoingstent-based PCI should be treated with triple therapy consisting ofaspirin, clopidogrel, and warfarin. This combination is associatedwith an increased risk of bleeding, and use of bare-metal stentsshould be considered in these patients to limit the duration oftriple therapy.
阿司匹林和华法林不能提供足够的的保护作用防止支架血栓形成。植入支架的PCI患者应该应用阿司匹林、氯吡格雷和华法林三联治疗。三联治疗出血风险增加,这些患者应该考虑植入裸支架,以限制三联治疗的时间。

8. In patients who need long-term OAT, use of drug-eluting stentsshould be restricted to patients at very high risk of restenosis(long lesions, small vessels, diabetes). Alternative therapies(coronary artery bypass grafting [CABG], medical therapy,bare-metal stents) should be considered before implantingdrug-eluting stents in a patient who needs long-term OAT.
需要长期OAT的患者,DES支架应该只用于再狭窄风险非常高的患者(长病变、小血管病变、糖尿病)。需要长期OAT治疗的患者在植入DES之前,应该考虑替代性的治疗(CABG、药物治疗、裸支架)。

9. In patients on triple therapy, closer monitoring of INR targetedto 2.0-2.5 and use of proton pump inhibitors may help reduce therisk of bleeding.
三联治疗的患者,应密切监测INR,保持在2.0-2.5之间,使用PPI(质子泵抑制剂)或许可以降低出血的风险。

10. There are limited data on safety of cardiac surgery in patientswho are on OAT. Currently, these patients are bridged with heparinprior to surgery. In the event of need for emergent CABG in apatient on OAT, fresh frozen plasma and vitamin K may be used toreverse OAT and reduce the risk of bleeding.
有关OAT治疗的患者心脏手术安全性的资料有限。目前这些患者在手术前应过渡为肝素治疗。需要紧急CABG的OAT治疗的患者,可以使用新鲜冰冻血浆、VitK对抗OAT,减低出血的风险。
所属分类:编程相关Access    作者:荡凯网络    时间:2010-7-24 21:48:00

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