post_pci圍手術(shù)期抗血小板策略_項美香21、靜念園林好，人間良可辭。22、步步尋往跡，有處特依依。23、望云慚高鳥，臨木愧游魚。24、結(jié)廬在人境，而無車馬喧；問君何能爾？心遠(yuǎn)地自偏。25、人生歸有道，衣食固其端。post_pci圍手術(shù)期抗血小板策略_項美香post_pci圍手術(shù)期抗血小板策略_項美香21、靜念園林好，人間良可辭。22、步步尋往跡，有處特依依。23、望云慚高鳥，臨木愧游魚。24、結(jié)廬在人境，而無車馬喧；問君何能爾？心遠(yuǎn)地自偏。25、人生歸有道，衣食固其端。post-PCI圍手術(shù)期抗血小板策略浙江大學(xué)醫(yī)學(xué)院附屬第二醫(yī)院心內(nèi)科項美香ACC/AHA/SCAIFocusedUpdateoftheGuidelineforPercutaneousCoronaryIntervention

2007WritingCommitteeMembersSpencerB.KingIII,MD,MACC,FAHA,FSCAI,Co-ChairSidneyC.Smith,MD,FACC,FAHA,Co-ChairJohnW.Hirshfeld,Jr,MD,FACC,FAHA,FSCAIAliceK.Jacobs,MD,FACC,FAHA,FSCAIDouglassA.Morrison,MD,PhD,FACC,FSCAIDavidO.Williams,MD,FACC,FAHA,FSCAIpost_pci圍手術(shù)期抗血小板策略_項美香21、靜念園林好1postpci圍手術(shù)期抗血小板策略_項美香16張課件2postpci圍手術(shù)期抗血小板策略_項美香16張課件3postpci圍手術(shù)期抗血小板策略_項美香16張課件4postpci圍手術(shù)期抗血小板策略_項美香16張課件5AntiplateletTherapy

Patientsalreadytakingdailylong-termaspirinshouldtake75mgto325mgbeforePCI.

Nochanges

Patientsnotalreadytakingdailyaspirinshouldbegiven300mgto325mgofaspirinatleast2hoursandpreferably24hoursbeforePCI.

Nochange AfterPCI,inpatientswithoutallergyorincreasedriskofbleeding,aspirin162mgto325mgdailyshouldbegivenforatleast: 1monthafterBMS 3monthsaftersirolimus-elutingstent 6monthsafterpaclitaxel-elutingstent

Modifiedrecommendation

IIIIIaIIaIIaIIbIIbIIbIIIIIIIIIIIIIIaIIaIIaIIbIIbIIbIIIIIIIIIIIIIIaIIaIIaIIbIIbIIbIIIIIIIIIIIaIIaIIaIIbIIbIIbIIIIIIIIIAntiplateletTherapy 6Aspirin Allpost-PCIstentedpatientswithoutaspirinresistance,allergy,orincreasedriskofbleedingshouldbegivenaspirin162mgto325mgdailyforatleast: 1monthafterBMS 3monthsaftersirolimus-elutingstent 6monthsafterpaclitaxel-elutingstent

Long-termaspirinuseshouldbecontinuedindefinitelyat75mgto162mgdaily.

Modifiedrecommendation Inpatientsatincreasedriskofbleeding,lower-dose75mgto162mgofaspirinisreasonableduringtheinitialperiodafterstentimplantation.

NewrecommendationIIIIIaIIaIIaIIbIIbIIbIIIIIIIIIIIIIIaIIaIIaIIbIIbIIbIIIIIIIIIIIIIIaIIaIIaIIbIIbIIbIIIIIIIIIIIaIIaIIaIIbIIbIIbIIIIIIIIIAspirin Allpost-PCIstentedp7Aspirin2006ConsensusofChina:ASA100~300mgq.d.afterPCIatleast1month.Andthen75~100mgq.d.Aspirin8AspirinNotrialscomparedlowerdose(75-162mg)withhigherdoseaspirin(162-325mg)astheinitialcourseoftherapyafterDESinsubacuteorlatestentthrombosisTherecommendationaccordingtotheclinicaltrialprotocolHigherdoseaspirinincreasetheriskofbleedingInthepatientsathighriskofbleeding,theuseoflowdoseofaspirin.AspirinNotrialscomparedlowe9AspirinMajorbleedingeventsweremorefrequentlyinpatientsoftakingSA200mg+clopidogrel75mgthanthatoftakingASA100mg+clopidogrel75mgAntiplateleteffectscouldnotbeincreasedinhigherdoseofASAAspirin10Clopidogrel Forallpost-PCIpatientswhoreceiveaDES,clopidogrel75mgdailyshouldbegivenforatleast12monthsifnotathighriskofbleeding.Forpost-PCIpatientsreceivingasBMS,itshouldbegivenforaminimumof1monthandideallyupto12months(unlesspatientisatincreasedriskofbleedingthenitshouldbegivenforaminimumof2weeks).

Modifiedrecommendation Forallpost-PCInon-stentedSTEMIpatients,treatmentwithclopidogrelshouldcontinuefor14days.

Newrecommendation Long-termmaintenancetherapy(e.g.1year)withclopidogrelisreasonableinSTEMIandNSTEMIwhoundergoPCIwithoutreperfusiontherapy.

NewrecommendationIIIIIaIIaIIaIIbIIbIIbIIIIIIIIIIIIIIaIIaIIaIIbIIbIIbIIIIIIIIIIIIIIaIIaIIaIIbIIbIIbIIIIIIIIIIIaIIaIIaIIbIIbIIbIIIIIIIIIClopidogrel Forallpost-PCI11PerioperativeperiodUnderurgentsituation,thedurationstudiedforFDAapproval3monthsforSES6monthsforPESPerioperativeperiodUnderurge12PredictorsoflatestentthrombosisSmallvesselsMultiplelesionsLongstentsOverlappingstentsOstialorbifurcationlesionsSuboptimalstentresultLowEFAdvancedageDMRenalfailureASCPredictorsoflatestentthrom13PerioperativeperiodElectivesurgery:postponedfor1yearNotbedeferredsurgery,aspirintherapyconsideredinhighriskpatientswithDESSurgerywithlowriskofbleeding,continueDATPerioperativeperiodElectives14謝謝謝謝15謝謝46、我們?nèi)粢呀邮茏顗牡?，就再沒有什么損失?！突?/p>

47、書到用時方恨少、事非經(jīng)過不知難?！懹?/p>

48、書籍把我們引入最美好的社會，使我們認(rèn)識各個時代的偉大智者?！访罓査?/p>

49、熟讀唐詩三百首，不會作詩也會吟?！獙O洙

50、誰和我一樣用功，誰就會和我一樣成功?！刂x謝46、我們?nèi)粢呀邮茏顗牡?，就再沒有什么損失?！突?6post_pci圍手術(shù)期抗血小板策略_項美香21、靜念園林好，人間良可辭。22、步步尋往跡，有處特依依。23、望云慚高鳥，臨木愧游魚。24、結(jié)廬在人境，而無車馬喧；問君何能爾？心遠(yuǎn)地自偏。25、人生歸有道，衣食固其端。post_pci圍手術(shù)期抗血小板策略_項美香post_pci圍手術(shù)期抗血小板策略_項美香21、靜念園林好，人間良可辭。22、步步尋往跡，有處特依依。23、望云慚高鳥，臨木愧游魚。24、結(jié)廬在人境，而無車馬喧；問君何能爾？心遠(yuǎn)地自偏。25、人生歸有道，衣食固其端。post-PCI圍手術(shù)期抗血小板策略浙江大學(xué)醫(yī)學(xué)院附屬第二醫(yī)院心內(nèi)科項美香ACC/AHA/SCAIFocusedUpdateoftheGuidelineforPercutaneousCoronaryIntervention

2007WritingCommitteeMembersSpencerB.KingIII,MD,MACC,FAHA,FSCAI,Co-ChairSidneyC.Smith,MD,FACC,FAHA,Co-ChairJohnW.Hirshfeld,Jr,MD,FACC,FAHA,FSCAIAliceK.Jacobs,MD,FACC,FAHA,FSCAIDouglassA.Morrison,MD,PhD,FACC,FSCAIDavidO.Williams,MD,FACC,FAHA,FSCAIpost_pci圍手術(shù)期抗血小板策略_項美香21、靜念園林好17postpci圍手術(shù)期抗血小板策略_項美香16張課件18postpci圍手術(shù)期抗血小板策略_項美香16張課件19postpci圍手術(shù)期抗血小板策略_項美香16張課件20postpci圍手術(shù)期抗血小板策略_項美香16張課件21AntiplateletTherapy

Patientsalreadytakingdailylong-termaspirinshouldtake75mgto325mgbeforePCI.

Nochanges

Patientsnotalreadytakingdailyaspirinshouldbegiven300mgto325mgofaspirinatleast2hoursandpreferably24hoursbeforePCI.

Nochange AfterPCI,inpatientswithoutallergyorincreasedriskofbleeding,aspirin162mgto325mgdailyshouldbegivenforatleast: 1monthafterBMS 3monthsaftersirolimus-elutingstent 6monthsafterpaclitaxel-elutingstent

Modifiedrecommendation

IIIIIaIIaIIaIIbIIbIIbIIIIIIIIIIIIIIaIIaIIaIIbIIbIIbIIIIIIIIIIIIIIaIIaIIaIIbIIbIIbIIIIIIIIIIIaIIaIIaIIbIIbIIbIIIIIIIIIAntiplateletTherapy 22Aspirin Allpost-PCIstentedpatientswithoutaspirinresistance,allergy,orincreasedriskofbleedingshouldbegivenaspirin162mgto325mgdailyforatleast: 1monthafterBMS 3monthsaftersirolimus-elutingstent 6monthsafterpaclitaxel-elutingstent

Long-termaspirinuseshouldbecontinuedindefinitelyat75mgto162mgdaily.

Modifiedrecommendation Inpatientsatincreasedriskofbleeding,lower-dose75mgto162mgofaspirinisreasonableduringtheinitialperiodafterstentimplantation.

NewrecommendationIIIIIaIIaIIaIIbIIbIIbIIIIIIIIIIIIIIaIIaIIaIIbIIbIIbIIIIIIIIIIIIIIaIIaIIaIIbIIbIIbIIIIIIIIIIIaIIaIIaIIbIIbIIbIIIIIIIIIAspirin Allpost-PCIstentedp23Aspirin2006ConsensusofChina:ASA100~300mgq.d.afterPCIatleast1month.Andthen75~100mgq.d.Aspirin24AspirinNotrialscomparedlowerdose(75-162mg)withhigherdoseaspirin(162-325mg)astheinitialcourseoftherapyafterDESinsubacuteorlatestentthrombosisTherecommendationaccordingtotheclinicaltrialprotocolHigherdoseaspirinincreasetheriskofbleedingInthepatientsathighriskofbleeding,theuseoflowdoseofaspirin.AspirinNotrialscomparedlowe25AspirinMajorbleedingeventsweremorefrequentlyinpatientsoftakingSA200mg+clopidogrel75mgthanthatoftakingASA100mg+clopidogrel75mgAntiplateleteffectscouldnotbeincreasedinhigherdoseofASAAspirin26Clopidogrel Forallpost-PCIpatientswhoreceiveaDES,clopidogrel75mgdailyshouldbegivenforatleast12monthsifnotathighriskofbleeding.Forpost-PCIpatientsreceivingasBMS,itshouldbegivenforaminimumof1monthandideallyupto12months(unlesspatientisatincreasedriskofbleedingthenitshouldbegivenforaminimumof2weeks).

Modifiedrecommendation Forallpost-PCInon-stentedSTEMIpatients,treatmentwithclopidogrelshouldcontinuefor14days.

Newrecommendation Long-termmaintenancetherapy(e.g.1year)withclopidogrelisreasonableinSTEMIandNSTEMIwhoundergoPCIwithoutreperfusiontherapy.

NewrecommendationIIIIIaIIaIIaIIbIIbIIbIIIIII