1、口服抗凝治疗的进展与实践北京大学人民医院 心脏中心孙艺红What is new in anticoagulation?Treatment RegimensClopidogrel 600 mg at least 2 hours before PCIAspirin 325 mg orally or intravenouslyBivalirudin group Bolus of 0.75 mg/kg Infusion of 1.75 mg/kg/hrUFH group Bolus of 140 U/kg Placebo InfusionClopidogrel 75-150 mg/day until
2、discharge (3 days) 75 mg/day for at least 6 monthsAspirin 80-325 mg/day indefinitelyDouble-blind randomization; double-dummy administrationISAR-REACT 3 ACC 2008Days after randomizationCumulative incidence (%)02468100 5 10 15 20 25 30Primary (Quadruple) EndpointDeath, MI, UTVR, Major Bleeding 8.3%8.7
3、%RR=0.94 95% CI, 0.77-1.15, P=0.57BivalirudinUFHISAR-REACT 3 ACC 2008Incidence (%)P=0.008Bleeding EventsP=0.0001 P=0.15BivalirudinUFHISAR-REACT 3 ACC 2008支架内血栓形成复发危险高n 437例患者发生一次支架内血栓形成患者随访 4年 ;n 74（ 16.9%）例患者至少复发一次 ;n 支架血栓复发的独立危险因素：首次支架内血栓形成后再次植入支架 (OR:： 4.2； 95%CI, 2.3-7.6; p90 mL/min; Prior Vascu
4、lar disease is defined as prior PAD or strokePredictor Range ScoreBaseline Hematocrit (%) 15-3030-6060-9090-1201203935281770Heart rate (bpm) 7071-8081-9091-100101-110111-120 121013681011Sex MaleFemale08Signs of CHF at presentation NoYes07Prior Vascular Disease NoYes06Diabetes Mellitus NoYes06Systolic blood pressure (mm Hg) 9091-100101-120121-180181-200 2011085135ACC 2008Who needs long-term anticoagulation?
