磺达肝葵钠解读.pptxVIP

American College of Chest Physicians Evidence-BasedClinical Practice Guidelines(9th Edition) ACCP9 – About FondaparinuxA first-generation synthetic analog of the antithrombin-binding pentasaccharideThe prototype for most of the new indirect factor Xa inhibitorsLicensed for prevention of VTE in patients undergoing high-risk orthopedic surgery and, in some countries, in general surgical or medical patientsA substitute for heparin or LMWH for initial treatment of VTELicensed in Europe and Canada, but not in the United States, as an alternative to heparin or LMWH for the treatment of ACS Three of the newer indirect factor Xa inhibitors, idraparinux, idrabiotaparinux, and SR123781A,are second- and third-generation variants（变异体） of fondaparinuxFondaparinux is given at a fixed dose of 2.5 mg daily for thromboprophylaxis and for the treatment of ACSFor treatment of DVT or pulmonaryembolism 5 mg : weight 50 kg 7.5 mg : weight 50 to 100 kg 10 mg : weighing 100 kg.routine coagulation monitoring is not recommendedpatients with moderate renal insufficiency (ie, CrCl 30-50 mL/min), the dose of fondaparinux should be reduced by 50%contraindicated in patients with renal insufficiency (CrCl 30 mL/min)2.1.8—2.1.11 房颤患者抗凝的选择AspirinClopidogrelOral anticoagulation remarksDabigatranVKAlow risk （0）IntermediateRisk(1) Unable for OAhigh risk(≥2) Unable for OAAF and mitral stenosisUnable for OADabigatran 150mg bid推荐应用：更好的选择： Perioperative Management patients temporary interruption of a VKA before surgerystopping VKAs approximately 5 days before surgery （1C）1.mechanical heart valve2. Atrial fibrillation 3. High risk of thromboembolismserial imaging of th（2C）e Bridging Anticoagulation Bridging AnticoagulationBridging anticoagulation as the administration of a short-acting anticoagulantSubcutaneous (SC) LMWH or IV UFH10- to 12-day during interruption of VKA therapy Prevention of VTE in Hospitalized Acutely Ill Medical Patients acutely ill hospitalized medical patients initial trea