ACS抗凝与出血风险的再认识(济南)201010.ppt

ACS患者抗凝与出血风险再认识 山东大学齐鲁医院 陈玉国 2010. 10. 23 出血易感人群及相关因素 ACS患者出血导致不良预后 基于出血的30天死亡事件OASIS 注册、 OASIS-2及CURE研究 (n=34146) ACS患者出血使死亡率升高的机制 血流动力学障碍 交感神经兴奋状态 输血诱发的微循环失调、NO耗竭、免疫作用 炎症反应 停用抗血栓药 * * * * As seen in this nomogram each predictor receives a score based on the range of that predictor. For example, a patient with baseline hematocrit of 29 would receive a score of 9. To test the reliability of the CRUSADE Bleeding Score, we calculated c-statistics for the Bleeding Score in the derivation and validation cohort. Like the multivariate regression model, the Crusade Bleeding Score was able to accurately discriminate a patient’s baseline risk of major bleeding w/ a c-statistic of 0.71 in the derivation cohort and c=0.70 in the validation cohort. For the subgroup analysis, patients were divided into approximately equal sized quintiles of risk groups based on their CRUSADE Bleeding Score * * * * * OASIS 5 was a randomized, double-blind, double-dummy trial in 20,078 patients with UA/NSTEMI in 576 centers in 41 countries Patients were eligible if they presented to hospital with symptoms of UA or MI without persistent ST elevation and at least two of the following additional criteria: age 60 years, troponin T or I or CK-MB above the upper limit of normal or ECG changes compatible with ischemia (i.e., ST depression at least 1 mm in two contiguous leads or T-wave inversion 3 mm or any dynamic ST shift or transient ST elevation). Exclusion criteria were: Age 21 years Any contra-indication to enoxaparin Hemorragic stroke 12 months Creatinine 3 mg/dL or 265 μmol/L Fondaparinux was given for 8 days or until hospital discharge (if earlier), and enoxaparin was given for 2-8 days or until the patient was clinically stable, as per its current approval for use in UA and NSTEMI. The minimum duration of therapy was two days. However, catheterization and PCI could be scheduled earlier than this time if necessary. Blinded study