急性冠脉综合征患者行经皮冠状动脉介入术使用抗血栓药物指南的系统评价

Guidelines systematic review of antithrombotic drugs in patients undergoing percutaneous coronary intervention

目的比较各指南对急性冠脉综合征(ACS)患者行经皮冠状动脉介入术(PCI)常用抗血栓药物的推荐异同,供临床医生用药参考。方法通过搜索国内外数据库,纳入符合标准的指南,利用指南评价工具(AGREE)评价指南;并按设定的结局指标,分析各指南对行PCI患者抗血栓药物推荐。结果纳入10篇指南均质量高。各指南都推荐术后使用阿司匹林+P2Y12受体拮抗剂双抗治疗;推荐术中需要使用普通肝素、比伐卢定等抗凝药物,并且在一般情况下,联合血小板糖蛋白Ⅱb/Ⅲa受体拮抗剂(GPA)可更大获益。对在PCI上游是否使用GPA制剂以及对磺达肝癸钠的使用建议等方面存在较大差异。结论入选指南对抗血栓药物使用推荐总体上是趋于一致的,但因入选指南目标人群、发布时间不同等原因,在细节上存在一定的差异。临床医生需要对ACS患者个体化评价后,再决定抗血栓治疗策略。

AIM To compare the similarities and differences of the guidelines for recommended antithrombotic drugs to acute coronary syndrome（ ACS） in patients undergoing percutaneous coronary intervention（ PCI）. METHODS By searching the domestic and foreign database to identify guidelines which met the inclusion criteria, utilization evaluation tools evaluation guidelines. According to the set outcomes, the uses of recommended antithrombotic drugs were analyzed. RESULTS The qualities of the ten guidelines were high. All guidelines recommended aspirin ＋ P2Y12 receptor antagonists therapy after PCI and recommended to use unfractionated heparin or bivalirudin or other anticoagulant drugs during the PCI, and in general, combined GPA will receive more benefit. There was a big difference on whether pre- treatment with GP IIb/IIIa antagonists in patients and use of fondaparinux sodium. CONCLUSION Guideline recommended for antithrombotic drug use was consistent in general, but there were still some differences in details because of different target groups,release time or other reasons. The individualized evaluations of patients with ACS were need for the clinicians,and then the antithrombotic treatment strategies were decided.