新版指南解读：急性ST段抬高型心肌梗死的抗栓治疗

急性ST段抬高型心肌梗死（STEMI）是冠状动脉内血栓形成的急性心血管事件，无论是行急诊经皮冠状动脉介入还是药物溶栓，抗栓始终贯穿于治疗的全过程。由于近年来一些大规模随机临床试验结果的公布，欧洲心脏病学会（ESC）、美国心脏病学会基金会（ACCF）及美国心脏协会（AHA）相继公布了ST段抬高型心肌梗死的新版指南。指南指出：急性STEMI一旦确诊，应立即行抗血小板及抗凝治疗，抗血小板治疗为负荷量的阿司匹林（300 mg）及二磷酸腺苷（ADP）受体拮抗剂（氯吡格雷300～600 mg、普拉格雷60 mg、替格瑞洛180 mg）；ESC指南更倾向于使用替格瑞洛或普拉格雷；2个指南维持量的阿司匹林均倾向于小剂量（75～100 mg/d）。新指南对于低分子量肝素应用于急诊PCI的推荐力度有所下降，建议维持时间≤8 d。基于有效性和安全性的考虑，2个指南均建议在STEMI行急诊PCI时使用比伐芦定，尤其是对于伴有高出血风险的患者。

Interpretation of ESC/ACCF/AHA new guidelines on antithrombotic therapy for acute ST-segment elevation myocardial infarction

Acute ST-segment elevation myocardial infarction（STEMI）is an acute cardiovascular event with coronary thrombosis.Antithrombotic runs through the whole process of both emergent per-cutaneous coronary intervention and thrombolytic therapy.In recent years,numerous new guidelines about the STEMI have been issued successively by European Society of Cardiology（ESC）,American College of Cardiology Foundation（ACCF）and American Heart Association（AHA）,in view of some of the published results of large randomized clinical trials.The new guidelines state that once acute STEMI is identified,immediate antiplatelet and anticoagulant therapy should be launched.The load-ing doses of aspirin （300 mg）and ADP receptor antagonists （clopidogrel 300-600 mg,prasugrel 60 mg,ticagrelor 180 mg）are in the front of antiplatelet therapy.The ESC guidelines prefer ti-cagrelor and prasugrel .The two guidelines employed a single daily maintenance dose of low-dose as-pirin （75 -100 mg/d）.In emergency PCI,the guidelines recommend that low molecular weight heparin is still important but less glamorous than before and its sustained time is no longer than 8 days.Meanwhile,based on efficacy and safety considerations,bivalirudin would be more preferable in STEMI undergoing emergency PCI ,especially for the patients with high risk of bleeding.