推薦建議 |
推薦級別 |
1、冠狀動脈旁路移植（CABG）術前和術後6小時內應該用阿司匹林，推薦劑量為81—325 mg/d，然後繼續使用阿司匹林，無明確期限，以減少移植閉塞和不良心髒事件。
|
1類推薦，A級證據 |
2、非體外循環CABG(off-pump CABG)術後，應用阿司匹林（81–162 mg /d）聯合氯吡格雷（75 mg/ d）的雙聯抗血小板治療達1年。
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1類推薦，A級證據 |
3、對於CABG術後因阿司匹林不耐受或者過敏的患者，氯吡格雷（75 mg/ d）是其合理選擇，繼續無限製使用氯吡格雷是合理的。
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IIa類推薦，C級證據 |
4、對於急性冠脈綜合征患者，雖然有關CABG人群的前瞻性臨床研究數據尚缺乏，但CABG術後給予其阿司匹林聯合普拉格雷或替格瑞洛（首選氯吡格雷）是合理的。
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IIa類推薦，B級證據 |
5、CABG術後進行單一抗血小板治療，考慮更高劑量的阿司匹林（325 mg /d，而非81 mg/ d）是合理的，大概是為了防止阿司匹林抵抗，但患者獲益尚不十分明確。
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IIa類推薦，A級證據 |
6、對於近期無急性冠脈綜合征的患者，體外循環CABG(on-pump CABG)術後可考慮給予其1年的阿司匹林聯合氯吡格雷雙聯抗血小板治療。 |
IIb類推薦，A級證據 |
2月9日，美國心髒學會(AHA)在《循環》(Circulation)雜誌上發布了《AHA科學聲明：冠狀動脈旁路移植術後二級預防》。醫學論壇網小編為您編譯了該聲明的抗血小板治療和抗栓治療、β受體阻滯劑治療、合並疾病的管理、預防和康複推薦要點。
更多內容請點此下載原文：AHA科學聲明：冠狀動脈旁路移植術後二級預防
抗血小板治療英文原文：
Secondary Prevention After Coronary Artery Bypass Graft Surgery
A Scientific Statement From the American Heart Association
Antiplatelet Therapy Recommendations
1. Aspirin should be administered preoperatively and within 6 hours after CABG in doses of 81 to 325mg daily. It should then be continued indefinitely to reduce graft occlusion and adverse cardiac events (Class I; Level of Evidence A).
2. After off-pump CABG, dual antiplatelet should be administered for 1 year with combined aspirin (81–162 mg daily) and clopidogrel 75 mg daily to reduce graft occlusion (Class I; Level of Evidence A).
3. Clopidogrel 75 mg daily is a reasonable alternative after CABG for patients who are intolerant of or allergic to aspirin. It is reasonable to continue it indefinitely (Class IIa; Level of Evidence C).
4. In patients who present with acute coronary syndrome,it is reasonable to administer combination
antiplatelet therapy after CABG with aspirin and either prasugrel or ticagrelor (preferred over clopidogrel),although prospective clinical trial data from CABG populations are not yet available (Class IIa;Level of Evidence B).
5. As sole antiplatelet therapy after CABG, it is reasonable to consider a higher aspirin dose (325 mg
daily) rather than a lower aspirin dose (81 mg daily),presumably to prevent aspirin resistance, but the
benefits are not well established (Class IIa; Level ofEvidence A).
6. Combination therapy with both aspirin and clopidogrel for 1 year after on-pump CABG may be considered
in patients without recent acute coronary syndrome, but the benefits are not well established(Class IIb; Level of Evidence Level A).
