在ST段升高心肌梗塞中,使用未分离的肝素进行初始非治疗性抗凝剂的预测者
Susan Cheng1, David A Morrow, Sarah Sloan
1Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
Circulation
|February 25, 2009
概括
在ST段升高心肌梗塞中使用未分离的肝素实现治疗性抗凝剂是具有挑战性的. 非理想的激活部分血栓形成时间 (aPTT) 会增加出血或再发作的风险,特别是在易受伤害的患者中.
科学领域:
- 心脏病学 心脏病学
- 药理学 药理学 是一个学科.
- 临床试验 临床试验
背景情况:
- 基于体重的诺基图旨在优化ST段升高心肌梗塞 (STEMI) 的未分离氨酸 (UFH) 剂量.
- 尽管有nomograms,实现UFH的治疗抗凝剂仍然是一个临床挑战.
研究的目的:
- 为了评估在接受纤维解药治疗的STEMI患者中基于体重的标准UFH名谱的有效性.
- 确定与非治疗性抗凝剂相关的因素及其临床结果.
主要方法:
- 对从ExTRACT-TIMI 25研究中接受UFH和纤维解的6055名STEMI患者的分析.
- 在UFH开始后4-8小时内监测激活的部分血栓形成时间 (aPTT).
- 评估影响aPTT水平的因素,以及与出血和心脏病复发事件的关联.
主要成果:
- 只有33.8%的初始aPTT在治疗范围内 (1.502.00倍控制).
- 显著高的aPTT (≥2.75倍于对照组) 发生在16.3%的患者中,并且与增加的出血风险有关.
- 显著低的aPTT (<1.25倍于对照组) 发生在13.2%的患者中,并趋向于增加复发性心脏病发作风险.
- 年龄较大,女性性别,体重较低和功能障碍与较高的aPTTs有关.
结论:
- 基于标准体重的UFH名谱经常导致STEMI中的非治疗性抗凝剂.
- 易受伤害的患者群体更容易发生低于最佳的抗凝血药物.
- 过度的抗凝剂会增加出血风险,而不充分的抗凝剂会增加复发风险.
相关概念视频
Anticoagulant Drugs: Low-Molecular-Weight Heparins
Hemostasis is a crucial process that prevents excessive blood loss from damaged blood vessels. It involves various mechanisms such as vasoconstriction, platelet adhesion and activation, and fibrin formation. The importance of each mechanism depends on the type of vessel injury. In contrast, thrombosis is the abnormal formation of a blood clot within the blood vessels, leading to potential complications if the clot obstructs blood flow. Thrombosis can be caused by increased coagulability of the...
Venous Thrombosis III: Interprofessional Care
Venous thrombosis requires effective prevention and treatment strategies to improve patient outcomes and reduce potential complications.Prevention StrategiesHealthcare providers must prioritize preventing venous thromboembolism (VTE) for all adult patients upon admission. Interventions depend on bleeding and thrombosis risk, medical history, current medications, diagnoses, planned procedures, and patient preferences. Patients on bed rest should change positions every two hours and, if not...
Acute Coronary Syndrome I: Introduction
Acute Coronary Syndrome (ACS) encompasses a spectrum of heart conditions caused by sudden obstruction of coronary arteries, typically resulting from the rupture of an atherosclerotic plaque and subsequent thrombus (blood clot) formation. This obstruction can lead to partial or complete blockage of blood flow, causing varying degrees of myocardial ischemia or infarction.ACS includes the following clinical entities:Unstable Angina (UA)Non-ST-Elevation Myocardial Infarction (NSTEMI)ST-Elevation...
Acute Coronary Syndrome III: Diagnostic Studies
Diagnosing acute coronary syndrome or ACS begins with a thorough patient history. Notable symptoms include central, crushing chest pain radiating to the left arm, neck, jaw, or back, along with shortness of breath, sweating (diaphoresis), nausea, vomiting, dizziness, and palpitations.It is crucial to note any history of cardiac illnesses and assess risk factors, including age, gender, smoking, hypertension, diabetes, hyperlipidemia, and a sedentary lifestyle.During physical examination, vital...
Acute Coronary Syndrome IV: Interprofessional Care
IntroductionThe management of Acute Coronary Syndrome (ACS) aims to minimize myocardial damage, preserve myocardial function, and prevent complications.Initial ManagementInpatient management involves continuous cardiac monitoring, preferably in an ICU, focusing on blood pressure, serum sodium, potassium, and creatinine levels, and urine output. Ongoing pharmacologic management is crucial for stabilizing the patient.Supplemental Oxygen: Administer supplemental oxygen if oxygen saturation is...
Anticoagulant Drugs: Vitamin K Antagonists and Direct Oral Anticoagulants
Oral anticoagulants are vital tools in preventing and treating blood clotting disorders. This diverse class of medications can be categorized as vitamin K antagonists, exemplified by warfarin, and direct thrombin inhibitors (DTIs), such as dabigatran, as well as factor Xa inhibitors, including rivaroxaban.
Warfarin, a prominent vitamin K antagonist family member, exerts its effect by inhibiting the enzyme VKORC1 (vitamin K epoxide reductase complex 1). By hindering this enzyme, warfarin...
Warfarin, a prominent vitamin K antagonist family member, exerts its effect by inhibiting the enzyme VKORC1 (vitamin K epoxide reductase complex 1). By hindering this enzyme, warfarin...
