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khi có triệu chứng bệnh động mạch vành là hiện tại. Tác dụng có lợi của glycoprotein IIb / IIIa chất ức chế nổi bật trong các môn học tiểu đường, người yêu cầu can thiệp mạch vành qua da (PCI) | 114 Schneider and Sobel when symptomatic coronary artery disease is present. Beneficial effects of glycoprotein IIb IIIa inhibitors are striking in diabetic subjects who require percutaneous coronary interventions PCI . Analysis of results in diabetic subjects with acute coronary syndromes demonstrates that treatment of diabetic patients with acute coronary syndromes undergoing PCI with tirofiban reduces the 30-day incidence of death or myocardial infarction from 15.5 to 4.7 . Similarly treatment with abciximab during elective percutaneous coronary intervention reduces the mortality rate after 1 year from 4.5 to 2.5 . Accordingly GP IIb IIIa inhibitors should be used aggressively in the treatment of diabetic subjects with acute coronary syndromes unstable angina and non-ST-elevation myocardial infarction and uniformly in association with percutaneous coronary intervention. As noted above hypertension should be treated vigorously generally with ACE inhibitors because of their demonstrated renal protective effects and normalization of the imbalance in the fibrinolytic system of diabetic subjects. Treatment with ACE-inhibitors is associated with a reduced rate of recurrent coronary thrombosis. Results both in vitro and in vivo demonstrate that ACE inhibition by decreasing formation of angiotensin-II and angiotensin-IV decreases expression of PAI-1. Thus ACE-inhibitor therapy is likely to reduce cardiovascular events through diverse mechanisms including its effect on the decreased fibrinolytic capacity in diabetes. VI. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Subjects with diabetes mellitus have a high prevalence and rapid progression of cardiovascular peripheral vascular and cerebral vascular disease secondary and in part attributable to 1 increased platelet reactivity 2 increased prothrom-botic activity reflecting increased concentrations and activity of coagulation factors and decreased activity of antithrombotic factors and 3 decreased fibrinolytic system capacity
