抗血小板治疗的出血风险控制讲解.ppt

Lowering APT dose？ 50mg vs 75mg clopidogrel 50mg vs 75mg clopidogrel Ticagrelor 60mg bid VS 90mg bid PEGASUS Study Conclusion for lowering doses Lower doses may decrease bleeding Need more data to support the efficacy and safety Figure 1 Study End Points. Shown are Kaplan–Meier event rates at 2 years in the two study groups for the primary efficacy end point (a composite of death from cardiovascular causes, myocardial infarction, stroke, recurrent ischemia with rehospitalization, or urgent coronary revascularization) (Panel A) and the key secondary efficacy end point (a composite of death from cardiovascular causes, myocardial infarction, or stroke) (Panel B). Table 3 Efficacy End Points. Figure 2 Risk of Bleeding. Shown are Kaplan–Meier event rates at 2 years in the two study groups for Global Use of Strategies to Open Occluded Coronary Arteries (GUSTO) criteria for moderate or severe bleeding (Panel A) and for Thrombolysis in Myocardial Infarction (TIMI) criteria for clinically significant bleeding (Panel B). Table 4 Bleeding End Points in the As-Treated Population. 比伐卢定是 20 个氨基酸的肽类药物，可以与游离或血栓中的凝血酶催化位点、阴离子外围位点特异性结合，是凝血酶的直接抑制剂。 比伐卢定与凝血酶的结合过程是可控可逆的。 比伐卢定作为一种直接的凝血酶抑制剂在冠脉患者中可产生一种可预测的抗凝效果，是一种耐受性极佳的抗凝血酶药物。 比伐卢定血浓度与 APTT、PT和 ACT 正相关，相关系数（r）分别为 0.77、0.73和 0.8（P＜0.001) 比伐卢定不需要抗凝血酶Ⅲ（AT-Ⅲ）作为辅助因子，从而使其抗凝作用与量效关系更吻合； 比伐卢定对血栓中的凝血酶或循环中的凝血酶的抑制作用几乎相同，而血栓中的凝血酶对肝素的拮抗作用比循环中的凝血酶强 20 倍； 比伐卢定不受激活血小板的影响，而肝素可被已激活的血小板释放的血小板因子 4（PTF-4）或其它物质中和； 比伐卢定不减少血小板 * * * 前瞻随机对照试验比较行血管成形术 AMI 患者肝素加用 IIb/IIIa 抑制剂Vs单用比伐卢定的疗效 – One Year Results – Roxana Mehran MD for the HORIZONS-AMI Investigators, TCT 2008 Key Message: HORIZONS AMI builds on a wealth of experience with bivalirudin across a spectrum of patients with acute coronary syndromes (ACS) undergoing PCI and supports the major landmark trials REPLACE-21 and ACUITY.2 References 1. Lincoff AM, Bittl JA, Harrington RA, et al. Bivalirudin and provisional glycoprotein IIb/IIIa blockade compared with heparin and planned glycoprotein IIb/IIIa blocka