AHA声明：CABG术后二级预防之抗血小板治疗建议
推荐建议 推荐级别 1、冠状动脉旁路移植（CABG）术前和术后6小时内应该用阿司匹林，推荐剂量为81325 mg/d，然后继续使用阿司匹林，无明确期限，以减少移植闭塞和不良心脏事件。 1类推荐，A级证据 2、非体外循环CABG(off-pum
推荐建议 |
推荐级别 |
1、冠状动脉旁路移植（CABG）术前和术后6小时内应该用阿司匹林，推荐剂量为81—325 mg/d，然后继续使用阿司匹林，无明确期限，以减少移植闭塞和不良心脏事件。
|
1类推荐，A级证据 |
2、非体外循环CABG(off-pump CABG)术后，应用阿司匹林（81–162 mg /d）联合氯吡格雷（75 mg/ d）的双联抗血小板治疗达1年。
|
1类推荐，A级证据 |
3、对于CABG术后因阿司匹林不耐受或者过敏的患者，氯吡格雷（75 mg/ d）是其合理选择，继续无限制使用氯吡格雷是合理的。
|
IIa类推荐，C级证据 |
4、对于急性冠脉综合征患者，虽然有关CABG人群的前瞻性临床研究数据尚缺乏，但CABG术后给予其阿司匹林联合普拉格雷或替格瑞洛（首选氯吡格雷）是合理的。
|
IIa类推荐，B级证据 |
5、CABG术后进行单一抗血小板治疗，考虑更高剂量的阿司匹林（325 mg /d，而非81 mg/ d）是合理的，大概是为了防止阿司匹林抵抗，但患者获益尚不十分明确。
|
IIa类推荐，A级证据 |
6、对于近期无急性冠脉综合征的患者，体外循环CABG(on-pump CABG)术后可考虑给予其1年的阿司匹林联合氯吡格雷双联抗血小板治疗。 |
IIb类推荐，A级证据 |
2月9日，美国心脏学会(AHA)在《循环》(Circulation)杂志上发布了《AHA科学声明：冠状动脉旁路移植术后二级预防》。金宝搏网站登录技巧 小编为您编译了该声明的抗血小板治疗和抗栓治疗、β受体阻滞剂治疗、合并疾病的管理、预防和康复推荐要点。
更多内容请点此下载原文：AHA科学声明：冠状动脉旁路移植术后二级预防
抗血小板治疗英文原文：
Secondary Prevention After Coronary Artery Bypass Graft Surgery
A Scientific Statement From the American Heart Association
Antiplatelet Therapy Recommendations
1. Aspirin should be administered preoperatively and within 6 hours after CABG in doses of 81 to 325mg daily. It should then be continued indefinitely to reduce graft occlusion and adverse cardiac events (Class I; Level of Evidence A).
2. After off-pump CABG, dual antiplatelet should be administered for 1 year with combined aspirin (81–162 mg daily) and clopidogrel 75 mg daily to reduce graft occlusion (Class I; Level of Evidence A).
3. Clopidogrel 75 mg daily is a reasonable alternative after CABG for patients who are intolerant of or allergic to aspirin. It is reasonable to continue it indefinitely (Class IIa; Level of Evidence C).
4. In patients who present with acute coronary syndrome,it is reasonable to administer combination
antiplatelet therapy after CABG with aspirin and either prasugrel or ticagrelor (preferred over clopidogrel),although prospective clinical trial data from CABG populations are not yet available (Class IIa;Level of Evidence B).
5. As sole antiplatelet therapy after CABG, it is reasonable to consider a higher aspirin dose (325 mg
daily) rather than a lower aspirin dose (81 mg daily),presumably to prevent aspirin resistance, but the
benefits are not well established (Class IIa; Level ofEvidence A).
6. Combination therapy with both aspirin and clopidogrel for 1 year after on-pump CABG may be considered
in patients without recent acute coronary syndrome, but the benefits are not well established(Class IIb; Level of Evidence Level A).
相关文章
评论
我要跟帖
