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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。
Objective To compare the recommendations of different guidelines for patients with acute coronary syndrome (ACS) common percutaneous coronary interventions (PCI) commonly used antithrombotic drugs similar recommendation for clinicians medication reference. Methods By searching databases both at home and abroad, the guideline was included in the guideline and the guideline was used to evaluate the guidelines. The guideline of each guideline was given to evaluate the guidelines for the antithrombotic therapy in PCI patients. Results The quality of the 10 guidelines was high. Each guideline recommends the use of aspirin + P2Y12 receptor antagonist double-antibody therapy; recommended intraoperative need unfractionated heparin, bivalirudin and other anticoagulant drugs, and in general, combined platelet glycoprotein Ⅱ b / Ⅲ a receptor Antagonists (GPA) can be even more beneficial. There is a big difference in the use of GPA preparations in the upper PCI and the use of fondaparinux. Conclusions The recommended guidelines for use of antithrombotic drugs tend to be consistent in general, but there are some differences in the details due to the different target groups and time of release. Clinicians need individualized evaluation of ACS patients before deciding on an antithrombotic strategy.