???????(ACS) ????

1
???????(ACS) ????
2
ACS????????
ACS, acute coronary syndrome MI, myocardial
infarction UA, unstable angina NSTEMI,
nonST-segment elevation myocardial infarction
STEMI, ST-segment elevation myocardial
infarction PCI, percutaneous coronary
intervention. Cannon CP. J Thromb Thrombolysis.
19952205-218.
3
????????????
???? ?????
Von Willebrand ?????
????/ VIIa?????
?????
Xa
???(IIa)
?????
????
?????
GP IIb/IIIa ?????
4
UFH ?ACS??????
???????? ???
?????? ???
Theroux 1988
N243 N399 N69 N214 N285 N143
Risc Group 1980
Cohen 1990
Cohen 1994
Holdright 1994
Gurfinkel 1995
??????? (95CI 0.44-1.02)
0.01
0.1
1
10
? ? ? ? ?
Oler A, et al. JAMA 1996276(10)811-815.
5
????????
????(UFH) ????
????? 3-7 kDa ?Xa/?IIa 2-8
???? 15 kDa ?Xa/?IIa 1.0
?????? 1-3 kDa ?Xa/?IIa 10-50
??????
?? lt2 kDa ???Xa??

??????????????
Da ???
6
ACS??????????
Antiplatelet therapy Aspirin Clopidogrel /
ticlopidine IV GP IIb/IIIa inhibitors
Revascularization therapy PCI CABG
Anticoagulant therapy Enoxaparin
Bivalirudin Rivaroxaban Fondaparinux UFH
7
??,??????????
??????10????????
Reference Cohen M, et al. Circulation.
2000102?-826. Cohen M, et al. J Thromb
Thrombolysis.2000 10241-246. Simoons ML, et
al.Eur Heart J. 2001  22 13. Montalescot G, et
al. N Eng J Med 2006355(10)1006-17. The FRAXIS
study group. Eur Heart J 1999 201553-62.
Sherman DG, et al. Lancet 20073691347-55. The
SYNERGY Trial Investigators. JAMA 200429245-54
8
????,?????????
?? NSTE/ACS?????????UFH?LMWH

3 Circulation. 19991001593-1601. 4 N Engl J
Med. 1997337447-452. 10 European Heart J.
1999201553-62. 11 Circulation. 19979661-8.
9
2007 ACC/AHA NSTEMI ??????
10
STEMI????????????UFH???6???
30?????????-???????????,??????
????? 30?????/????/????
Murphy SA, et al. Eur Heart J. Epub 2007 Jun 28.
11
2007 ACC/AHA STEMI ??????
??ExTRACT-TIMI25?? FDA ????????STEMI ??????2007
ACC/AHA ????
12
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