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多年来,肝素是经皮冠状动脉介入术治疗仅有的抗凝药物,因此被默认为标准的抗凝药物.近年来的几项多中心试验表明急性心肌梗死经皮冠状动脉介入术治疗中,与肝素相比,比伐芦定能减少主要出血事件,但可能增加缺血事件,尤其使急性期支架内血栓风险增高.故目前ST段抬高型心肌梗死患者使用比伐芦定抗凝的疗效是否优于肝素仍存争议.为克服早期血栓风险,研究者尝试了多种策略:如延长比伐芦定的使用时间、联合应用起效更快的新型抗血小板药物、转运途中即开始抗凝治疗以及将负荷量比伐芦定从静脉注射改为冠状动脉内注射.“,”Over the years,heparin has been the only anticoagulant to treat percutaneous coronary intervention(PCI) and is thus con-sidered to be the standard anticoagulant. In recent years,several multi-center trials have shown that bivalirudin reduces the major bleeding e-vents in acute myocardial infarction compared with heparin in acute myocardial infarction,but may increase ischemic events,particularly in the early phase of stent thrombosis. Therefore,the current ST-segment elevation myocardial infarction patients with bivalirudin anticoagulant effect is better than heparin yet remains controversial. To overcome the risk of early thrombosis,researchers have tried several strategies that have included;extending the use of bivalirudin,combined use of faster onset of new anti-platelet drugs,anticoagulant treatment that began to transiting,and the load of bivalirudin changed from intravenous injection to intracoronary injection.