抗血小板抵抗潜在的风险因素ppt培训课件

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1、IsAntiplateletResistanceaPotentialRiskFactor?C.RichardContiM.D.MACCAntiplateletAgents:MechanismofActionCollagenThrombinTXA2ADPADP=adenosinediphosphate,TXA2=thromboxaneA2,COX=cyclooxygenase.SchaferAI.AmJMed.1996;101:199–209.clopidogrelbisulfateTXA2ADPADPGpIIb/IIIaActivationCOXas

2、pirinReoPro,Integrilin,AggrastatThromboxaneA2issynthesizedandreleasedbyhumanplateletsinresponsetoavarietyofstimuli(collagen,thrombin,ADP,PAF)andamplifiesplateletaggregationIsAspirinresistanceaRiskFactor?Aspirinisaneffectiveantiplateletagentwithprovenbenefitforthepreventionofather

3、othromboticcomplicationsofCVdiseaseHowever,ManypatientstakingaspirinhavecardiaceventsAspirinresistanceisestimatedanywherebetween5%and40%AspiriniscardioprotectiveInameta-analysisofpatientswithhighriskperipheralvasculardisease;ASAtherapywasassociatedwitha34%riskreductioninNonfatalM

4、I25%riskreductioninnonfatalstroke18%reductioninallcausemortality*BMJ2002,324:71-86AspirinResistance:AconfusingTermnotwelldefined!TIMIRiskscoreCompliance“allergy”-GIintoleranceTrueallergyMalabsorbtionInadequatedoseSmokingIncreasedcatecholaminelevelsTruefunctionalresistanceUA/NSTEM

5、ITIMIRISKSCOREVariablesAge653riskfactorsforCADPrior50%CorStenosisSTChangeonadmissionAnginaX2in24hrsASAusewithin7daysSerumCardiacMarkerDatafromTIMI11BandEssenceTrialsAdaptedfromAntmanEMetal.JAMA2000:284:835-842Death,MIRecurrentIschemiaat14daysWhatisAspirinResistanceTIMIRiskScoreC

6、ompliance“allergy”-GIintoleranceTrueallergyMalabsorbtionInadequatedoseSmokingIncreasedcatecholaminelevelsTruefunctionalresistanceWhyarepatientsaspirinresistantClinicalVariablesCigarettesNSAID’sSubtherapeuticdosesofASABiologicVariablesAlternatepathwaysofplateletactivationGeneticVa

7、riablesMutationsoftheCOX-1geneWhatisthebestwaytodetectAspirinResistance?Thereisno“one”goodwaytoassessplateletfunction.Theclinicalrelevanceof“AspirinResistance”asdeterminedbycurrentlaboratorymethodsisuncertain.HowcanaspirinresistancebedetectedBedsidepointofcaremeasurementofPlatele

8、tFunctionPFA100(plateletfunctionanalyser