pcl圍手術(shù)期藥物治療兒科學(xué)-資料下載頁
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【正文】 in 30day Death or MI with Eptifibatide vs Placebo (%) (n=2522) (n=2041) (n=3803) (n=1105) % ? ? 0% % ? Time from Onset of Symptoms Bhatt D, Topol E. JAMA. 2022。284:15491558. 6 hours 6–12 hours 12–24 hours 24 hours ? % ? % ? % GP IIb/IIIa Inhibitors: Reduction in Death/MI Associated with Time of Administration from Symptom Onset 4F Coronary Angioscope Intracoronary Ultrasound Common in Patients with Diabetes Schoenhagen P, et al. Arterioscler Thromb Vasc Biol. 2022。23:18951900. Asakura M, et al. J Am Coll Cardiol. 2022。37:12841288. Multiple “Vulnerable” Plaques in Patients with ACS GP IIb/IIIa Inhibitors in the PCI Setting Module 2: Aggressive Dosing Schedules for Reversible GP IIb/IIIa Inhibitors EPIC. N Engl J Med. 1994。330:956961. EPILOG. N Engl J Med. 1997。336:15891596. Patients (%) EPIC 15 10 5 0 CAPTURE EPILOG EPISTENT EPIC CAPTURE EPILOG EPISTENT Lowdose Heparin Abciximab + Stent Lowdose Heparin Abciximab + Stent Any Major Bleed NonCABG Major Bleed Internal Data, Centrocor. EPISTENT. Lancet. 1998。352:8792. * TIMI Criteria: Either an intracranial hemorrhage or a decrease in hemoglobin 5 g/dL. Abciximab Safety: Major Bleeding Events* Event Heparin + GP Bivalirudin Pvalue IIb/IIIa Inhibitor (n=2994) (n=3008) Major bleeding* 123 (%) 71 (%) Minor bleeding 772 (%) 400 (%) Lincoff AM, et al. JAMA. 2022。289:853863. * Major bleeding was defined as intracranial, intraocular, or retroperitoneal hemorrhage, clinically overt blood loss resulting in a decrease in hemoglobin of more than 3 g/dL, any decrease in hemoglobin of more than 4 g/dL, or transfusion of 2 or more units of packed red blood cells or whole blood. REPLACE 2: Bleeding Events at 30 Days Ferguson J, et al. Am Heart J. 1998。135:S77S89. Internal Data, Centrocor. Patients (%) EPIC 3 2 1 0 CAPTURE EPILOG EPISTENT Incidence of Severe Thrombocytopenia (Platelet Count 50,000/mm3) Placebo Abciximab Tirofiban TARGET Topol EJ, et al. N Engl J Med. 2022。344:18881894. Abciximab Safety: Results of Phase III Trials—Thrombocytopenia 欣維寧 (Tirofiban) ? 非太類血小板糖蛋白 Ⅱ b/Ⅲ a受體可逆性拮抗劑 ? 可抑制 ADP誘導(dǎo)的血小板聚集 (90%),延長BT ? 抑制作用與血藥濃度相平行 ,停藥后血小板功能恢復(fù)基線水平 欣維寧 藥代動(dòng)力學(xué) ? 與血漿蛋白結(jié)合率不高 ,分布廣泛 ? 在體內(nèi)基本無代謝 ,主要經(jīng)腎清除 ,少部分經(jīng)膽汁清除 ? 血漿半衰期約 ? 嚴(yán)重腎功能不全可降低血漿清除率 欣維寧 規(guī)格與用法 ? 規(guī)格 :100 ml(5mg)/瓶 ? ACS: 30分鐘負(fù)荷量 2535ml 維持量 :68ml/h,36小時(shí) ? PCI: 3分鐘負(fù)荷量 1015ml 維持量 :1015ml/h,36小時(shí) 欣維寧 注意事項(xiàng) ? 與肝素單獨(dú)應(yīng)用相比 ,有增加輕度出血危險(xiǎn) ? 可導(dǎo)致血小板降少 ,應(yīng)監(jiān)測(cè)血小板和血常規(guī) ? 應(yīng)用中監(jiān)測(cè) APTT,ACT ? 與肝素和用時(shí) ,應(yīng)考慮肝素減量 20% ? 過量可經(jīng)血液透析清出 ? 常規(guī)應(yīng)用硝酸酯類等抗心肌缺血藥 ? 積極控制危險(xiǎn)因素 ? 手術(shù)當(dāng)日早上停用 β受體阻滯劑，減少術(shù)中心率減慢反應(yīng)及術(shù)后迷走興奮反射。 Thanks Thanks Thanks Thanks Thanks Thanks Thanks Thanks Thanks Thanks Thanks Thanks Thanks
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