Cohen Marc, Hoekstra James
Cardiac Catheterization Laboratory, Newark Beth Israel Medical Center, Newark, NJ 07112, USA.
Am J Emerg Med. 2008 Oct;26(8):932-41. doi: 10.1016/j.ajem.2007.11.031.
Patients presenting to the Emergency Department (ED) need to be quickly diagnosed, risk-stratified, and treated accordingly. Anticoagulants used in the ED should be easy to use and suitable for all patients with acute coronary syndromes, regardless of treatment strategy. In patients with ST-segment myocardial infarction, current guidelines recommend unfractionated heparin regardless of reperfusion strategy or low-molecular-weight heparin (LMWH) as an alternative in patients undergoing percutaneous coronary intervention (PCI). The LMWH enoxaparin is approved for ST-segment elevation myocardial infarction patients managed medically or undergoing PCI. The recently updated American College of Cardiology/American Heart Association guidelines for patients with unstable angina or non-ST-segment elevation myocardial infarction recommend unfractionated heparin or the LMWH enoxaparin (class IA recommendation), or the factor Xa inhibitor fondaparinux or the direct thrombin inhibitor bivalirudin (class IB recommendation) for patients managed invasively. This review discusses each of these anticoagulant options in the context of patients transitioning to PCI.
前往急诊科（ED）就诊的患者需要迅速得到诊断、进行风险分层并接受相应治疗。急诊科使用的抗凝剂应易于使用，适用于所有急性冠状动脉综合征患者，无论其治疗策略如何。对于ST段抬高型心肌梗死患者，目前的指南推荐无论再灌注策略如何均使用普通肝素，对于接受经皮冠状动脉介入治疗（PCI）的患者，可选用低分子量肝素（LMWH）作为替代。低分子量肝素依诺肝素已被批准用于接受药物治疗或PCI的ST段抬高型心肌梗死患者。最近更新的美国心脏病学会/美国心脏协会针对不稳定型心绞痛或非ST段抬高型心肌梗死患者的指南推荐，对于接受侵入性治疗的患者，使用普通肝素或低分子量肝素依诺肝素（IA类推荐），或使用Xa因子抑制剂磺达肝癸钠或直接凝血酶抑制剂比伐卢定（IB类推荐）。本综述在患者过渡到PCI的背景下讨论了这些抗凝剂选项中的每一种。
