课件：术后支架内血栓形成及预防.ppt

INT.CLO.04.02.01 NOT FOR DISTRIBUTION/ FOR INTERNAL USE ONLY Please note that neither Sanofi-Synthelabo nor Bristol-Myers Squibb recommends the use of clopidogrel in any manner inconsistent with that described in the full prescribing information. * Premature discontinuation of antiplatelet therapy was a major significant univariate predictor of stent thrombosis. The cumulative incidence of thrombosis was 29% (5 of 17 patients), with a hazard ratio of 152 (95% Confidence interval; 52 to 442; P0.001); clopidogrel was discontinued in one patient. Other significant univariate predictors included prior brachytherapy, renal failure, bifurcation with 2 stents, bifurcation lesions, and diabetes, with respective cumulative thrombosis rates of 8.7%, 6.2%, 3.9%, 3.6%, and 2.5% (P0.05). Unstable angina, thrombus, and unprotected left main were not significant univariate predictors of thrombosis. Iakovou I, Schmidt T, Bonizzoni E, et al. Incidence, predictors, and outcome of thrombosis after successful implantation of drug-eluting stents. JAMA. 2005;293:2126-2130. INT.CLO.04.02.01 NOT FOR DISTRIBUTION/ FOR INTERNAL USE ONLY Please note that neither Sanofi-Synthelabo nor Bristol-Myers Squibb recommends the use of clopidogrel in any manner inconsistent with that described in the full prescribing information. * The Science Advisory addressed strategies that have the potential to reduce premature discontinuation of thienopyridine therapy, including: ?Before implantation of a stent, the physician should discuss the need for dual antiplatelet therapy. In patients not expected to comply with 12 months of thienopyridine therapy, whether for economic or other reasons, strong consideration should be given to avoiding a DES. ?In patients who are undergoing preparation for percutaneous coronary intervention and are likely to require invasive or surgical procedures within the next 12 months, consideration should be given to implantation of a BMS or performance of balloon angioplasty wi