【新整理】非st段抬高急性冠脈綜合征-wenkub.com
2024-11-20 22:00 本頁(yè)面
【正文】 g /kg/min infusion x 12 hours Abciximab (Reopro) 0.25 mg/kg bolus 0.125 181。 quality indicator Use in everyone without contraindications,Platelet GP IIb/IIIa Inhibition for NonST ? ACS Primary Endpoint Results from the 5 Major RCTs,All PCI trials 17,393 0.66 8.5 5.6 All ACS trials 24,311 0.89 12.8 11.4 ACS troponin (+) 1,368 0.42 16.3 6.9 ACS PCI 2,311 0.66 14.4 9.6 ACS no PCI 12,685 0.93 14.3 13.3 ACS troponin (–) 2,901 1.05 6.2 6.5,IIb/IIIa MetaAnalysis 30Day Death, MI at 30 Days,CP944328 1,Relative risk Placebo IIb/IIIa No. ratio (%) (%),Chew DP et al: JACC 2000。 n=3171) TIMI IIB (enoxaparin。324:71–86.,OR*,0.5,1.0,1.5,2.0,500–1500 mg 34 19 160–325 mg 19 26 75–150 mg 12 32 75 mg 3 13 Any aspirin 65 23,Antiplatelet Better,Antiplatelet Worse,Aspirin Dose No. of Trials (%),Odds Ratio,0,Aspirin Dose and Events in HighRisk Pts Frequency of CV Death, MI, Stroke,P=0.0001,CURE,CP9995472,Yusuf S et al NEJM 2001。 Lancet 2001。 14 Diabetes mellitus (%) 23 23 22 33 Prior CHF (%) 11 8 8 19 Prior PCI (%) 13 10 22 Prior CABG (%) 12 18* 8 20,NEJM 1998。 SD (yrs) 63 177。 11 63 177。339:436。357:191524,* CABG or PTCA,Antman EM et al N Engl J Med 1996。16:494502,NonST elevation ACS 12,562 patients,ASA 75 to 325 mg po qd placebo n=6,303,312 month followup (average 9 mo),ASA + clopidogrel (300 mg load, 75 mg qd) n=6,259,CURE: Aspirin Dose and Outcome,%,(N = 1,927),(N = 7,428),(N = 3,201),ASA/Clopidogrel ASA/Placebo,CV Death, MI, Stroke,Major Bleeding,Aspirin in ACS,More bleeding with higher doses, especially when combined with clopidogrel, coumadin Possibly greater efficacy with lower doses (not sure) I recommend: 165 mg once daily Guidelines: still recommend 81365 mg aspirin,CURE CV Death/MI/Stroke, 1 Year,CP9997313,CV death, MI, stroke (%),Clopidogrel (n=6,303),Placebo (n=6,259),P=0.00003,Days after enrollment,CURE,Event rate (%),RR 0.80 P=0.00005,CP9950586,CV death, MI, stroke,CV death,MI,Stroke,NonCV death,RR 0.92 P=NS,RR 0.77 P0.001,RR 0.85 P=NS,RR 0.96 P=NS,Restricted the participation of hospitals that pursue an invasive strategy in the majority of ACS pts The results ought to be applied to pts that resemble those enrolled in the trial There is reason to believe that early dual antiplatelet therapy might have different safety, efficacy in invasive vs. noninvasively managed pts,CURE,CURE Major/LifeThreatening Bleeds in the 7
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