Zagnoni Silvia, Casella Gianni, Musuraca Anna Chiara, Calabrese Daniela, Pavesi Pier Camillo, Di Pasquale Giuseppe
U.O. di Cardiologia, Azienda USL, Ospedale Maggiore, Bologna.
G Ital Cardiol (Rome). 2010 Dec;11(12 Suppl 3):34S-42S.
Acute coronary syndromes (ACS) are one of the most dramatic manifestations of atherothrombosis and several efforts have been made in recent years to improve their prognosis. Morbidity and mortality of high-to-medium risk ACS have significantly reduced in the real world setting during the last few years, due to a very aggressive antithrombotic therapy, which always involves a combination of an anticoagulant and different antiplatelet agents, and an extensive indication to revascularization. However, it has become increasingly important for clinicians to identify the correct treatment between the several different combination of antithrombotic and antiplatelet agents. The selection and intensity of these combinations are based in the first instance on the ischemic risk profile of the patient and the treatment strategy (early invasive, delayed invasive or conservative) selected. However, the use of such an aggressive antithrombotic therapy coupled with coronary angioplasty exposes the patients to a significant risk of bleeding. Unfortunately, these bleeding complications have a negative prognostic significance and force clinicians to suspend (or decrease) the antithrombotic treatments to control bleeding.
急性冠状动脉综合征（ACS）是动脉粥样硬化血栓形成最显著的表现之一，近年来人们为改善其预后做出了诸多努力。在过去几年的实际临床环境中，中高危ACS的发病率和死亡率显著降低，这得益于非常积极的抗栓治疗，该治疗通常包括抗凝剂和不同抗血小板药物的联合使用，以及广泛的血运重建指征。然而，对于临床医生来说，在几种不同的抗栓和抗血小板药物组合中确定正确的治疗方法变得越来越重要。这些组合的选择和强度首先基于患者的缺血风险状况以及所选择的治疗策略（早期侵入性、延迟侵入性或保守治疗）。然而，这种积极的抗栓治疗与冠状动脉血管成形术的联合使用使患者面临显著的出血风险。不幸的是，这些出血并发症具有负面的预后意义，迫使临床医生暂停（或减少）抗栓治疗以控制出血。
