2011ACC、AHA最新指南

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1、Table2.RecommendationsforAntiplateletTherapyClassI2007Recommendations2011FocusedUpdateRecommendationsCommentsASAshouldbeadministeredtoUA/NSTEMIpatientsassoonaspossibleafterhospitalpresentationandcontinuedindefinitelyinpatientsnotknowntobeintolerantofthatmedi

2、cation.(LevelofEvidence:A)(Figs.7and8;BoxA)Clopidogrel(loadingdosefollowedbydailymaintenancedose)shouldbeadministeredtoUA/NSTEMIpatientswhoareunabletotakeASAbecauseofhypersensitivityormajorgastrointestinalintolerance.(LevelofEvidence:A)(Figs.7and8;BoxA)InUA/N

3、STEMIpatientswithahistoryofgastrointestinalbleeding,whenASAandclopidogrelareadministeredaloneorincombination,drugstominimizetheriskofrecurrentgastrointestinalbleeding(e.g.,PPI),shouldbeprescribedconcomitantly.(LevelofEvidence:B)ForUA/NSTEMIpatientsinwhomanini

4、tialinvasivestrategyisselected,antiplatelettherapyinadditiontoASAshouldbeinitiatedbeforediagnosticangiography(upstream)witheitherclopidogrel(loadingdosefollowedbydailymaintenancedose)oranIVGPIIb/IIIainhibitor.(LevelofEvidence:A)Abciximabasthechoiceforupstream

5、GPIIb/IIIatherapyisindicatedonlyifthereisnoappreciabledelaytoangiographyandPCIislikelytobeperformed;otherwise,IVeptifibatideortirofibanisthepreferredchoiceofGPIIb/IIIainhibitor.(LevelofEvidence:B)ForUA/NSTEMIpatientsinwhomaninitialconservative(i.e.,noninvasiv

6、e)strategyisselected(seeSection3.3),clopidogrel(loadingdosefollowedbydailymaintenancedose)shouldbeaddedtoASAandanticoagulanttherapyassoonaspossibleafteradmissionandadministeredforatleast1month(LevelofEvidence:A)andideallyupto1year.(LevelofEvidence:B)(Fig.8;Bo

7、xC2)ForUA/NSTEMIpatientsinwhomaninitialconservativestrategyisselected,ifrecurrentsymptoms/ischemia,HForseriousarrhythmiassubsequentlyappear,thendiagnosticangiographyshouldbeperformed.(LevelofEvidence:A)(Fig.8;BoxD)EitheranIVGPIIb/IIIainhibitor(eptifibatideort

8、irofiban;LevelofEvidence:A)orclopidogrel(loadingdosefollowedbydailymaintenancedose;LevelofEvidence:A)shouldbeaddedtoASAandanticoagulanttherapybeforediagnosticangiography(upstream).(Levelo