Kadakia R A, Ferguson J J
Texas Heart Institute, St. Luke's Episcopal Hospital, Baylor College of Medicine, The University of Texas Health Science Center at Houston, Houston, TX, USA.
Minerva Cardioangiol. 2005 Feb;53(1):15-42.
Recent years have witnessed significant advances in the percutaneous treatment of patients with atherosclerotic vascular disease. Anti-platelet and anti-thrombotic agents are routinely administered to minimize the risk of peri-procedural myonecrosis, stent thrombosis and other procedural complications. This article presents a current view of optimal adjunctive antithrombotic therapy for percutaneous coronary interventions (PCI), recognizing that optimal is a necessarily subjective label. This article focuses specifically on anticoagulant agents such as unfractionated heparin (UFH), the low-molecular weight heparins (LMWH), and direct thrombin inhibitors, and antiplatelet agents, such as aspirin, thienopyridines, and glycoprotein IIb/IIIa antagonists. It starts with a general discussion of anticoagulation and percutaneous intervention, followed by a summary of the modern-day view of the coagulation process. The mechanism of action of the individual agents is then presented, followed by some of the evidence base of recent clinical trials of anticoagulant and antiplatelet agents in PCI. Finally, we present summary recommendations for procedural anticoagulation in low risk, not-low risk, and high risk PCI, and list what we feel are appropriate doses for the agents employed. Ultimately, though, it is the individual interventional cardiologists who must decide for themselves exactly what constitutes optimal antithrombotic therapy for PCI.
近年来，动脉粥样硬化性血管疾病患者的经皮治疗取得了重大进展。常规使用抗血小板和抗血栓药物，以尽量降低围手术期心肌坏死、支架血栓形成及其他手术并发症的风险。本文阐述了经皮冠状动脉介入治疗（PCI）最佳辅助抗血栓治疗的当前观点，同时认识到“最佳”是一个必然主观的标签。本文特别关注抗凝药物，如普通肝素（UFH）、低分子肝素（LMWH）和直接凝血酶抑制剂，以及抗血小板药物，如阿司匹林、噻吩吡啶类药物和糖蛋白IIb/IIIa拮抗剂。文章首先对抗凝和经皮介入治疗进行了一般性讨论，接着总结了当今对凝血过程的看法。然后介绍了各药物的作用机制，随后是近期PCI中抗凝和抗血小板药物临床试验的一些证据基础。最后，我们给出了低风险、非低风险和高风险PCI手术抗凝的总结性建议，并列出了我们认为所使用药物的合适剂量。然而，最终必须由个体介入心脏病专家自行决定究竟什么构成PCI的最佳抗血栓治疗。
