In patients with acute coronary syndrome (ACS), coagulation system activation, increased thrombin activity are common, the coagulation and fibrinolysis system dynamic balance is imbalanced, and the blood is in a hypercoagulable state . Percutaneous coronary intervention (PCI) is one of the main methods for the treatment of coronary heart disease, but PCI is an invasive operation. During the operation, the catheter contacts the vascular endothelial surface, which can induce the activation of the intrinsic/extrinsic coagulation system, activate thrombin, and activate thrombin. It promotes the conversion of fibrinogen into fibrin and finally forms a thrombus, so the pre-, mid- and post-PCI perioperative period is a high-incidence period of thrombotic events. This article will summarize the antiplatelet/anticoagulant drugs before and after PCI .
Whether anticoagulant or antiplatelet, the purpose isantithrombotic
Anticoagulation: refers to the process of reducing the intrinsic and extrinsic coagulation pathways and the process of reducing fibrin thrombus formation through the application of anticoagulant drugs. The commonly used anticoagulant drugs in the perioperative period of PCI are: 1. Unfractionated heparin; 2. 2. Enoxaparin; Bivalirudin. Anti-platelet: refers to the process of reducing platelet thrombus formation by taking anti-platelet drugs to reduce the adhesion and aggregation function of platelets.The commonly used antiplatelet drugs in the perioperative period of PCI are: 1. aspirin; 2. 2. P2Y12 receptor inhibitor; Glycoprotein IIb/IIIa receptor inhibitor.
Choice of antiplatelet and anticoagulant drugs before and after PCI
Elective PCI: Coronary angiography + PCI + drug therapy should be given to patients with PCI indications > 24 hours later.
Rescue PCI: In the latter case of failure of thrombolysis, transfer to a hospital where PCI can be performed within 3 to 24 hours of illness.
Indications:
Hemodynamically unstable;
Clinical manifestations of persistent myocardial ischemia persisted 45 to 60 minutes after thrombolysis;
with heart failure or pulmonary edema less than 12 hours after onset.
Summary
The rational use of antiplatelet and anticoagulant drugs is the key to ensuring the efficacy and safety of interventional surgery, which directly determines the success or failure of surgery and affects the short-term and long-term prognosis of patients. In clinical use, the efficacy and safety should be weighed according to the patient’s own situation, and different antiplatelet anticoagulant drugs should be used selectively.
Planning: Ren JingjingSubmission and cooperation: [email protected]Title: Visual China< p>