Sorbonne University, ACTION Group, INSERM UMRS 1166, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France.
Sorbonne University, ACTION Group, INSERM UMRS 1166, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France; PERFUSE Study Group, Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States.
Prog Cardiovasc Dis. 2018 Jan-Feb;60(4-5):508-513. doi: 10.1016/j.pcad.2018.01.004. Epub 2018 Jan 13.
Early intravenous anticoagulation is the corner stone treatment of patients admitted with an acute coronary syndrome: it antagonizes the ongoing coronary thrombosis and facilitates the percutaneous coronary intervention, hence a reduction of mortality and acute stent thrombosis. Unfractionated heparin, enoxaparin, bivalirudin and fondaparinux have been extensively studied in large randomized control trials and meta-analyses with the same objective: reducing the ischemic burden without hiking hemorrhagic events. This conundrum is evolving along the generalization of the radial-artery access, the use of potent P2Y12 and the trend towards a tailored approach regarding the ischemic and bleeding balance. In this systematic review, we aimed at presenting the evidence based data and strategies for each anticoagulant in the setting of acute coronary syndrome with and without ST-segment elevation.
它可以拮抗正在进行的冠状动脉血栓形成，并促进经皮冠状动脉介入治疗，从而降低死亡率和急性支架血栓形成。未分级肝素、依诺肝素、比伐卢定和磺达肝癸钠已在大型随机对照试验和荟萃分析中进行了广泛研究，目的相同：减少缺血负担，同时不增加出血事件。随着桡动脉入路的普及、强效 P2Y12 的使用以及对缺血和出血平衡的个体化方法的趋势，这个难题正在不断发展。在本系统评价中，我们旨在介绍急性冠状动脉综合征伴或不伴 ST 段抬高患者中每种抗凝剂的基于证据的数据和策略。
