Gurbel P A, O'Connor C M, Cummings C C, Serebruany V L
Center for Thrombosis Research, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Schapiro Research Building-R202, Baltimore, MD 21215, USA.
Pharmacol Res. 1999 Aug;40(2):107-11. doi: 10.1006/phrs.1999.0478.
Ticlopidine has become an established therapy in patients with stroke, and during stenting in patients with coronary artery disease. Clopidogrel, another thienopyridine, is a safe and promising alternative, that irreversibly inhibits ADP-induced platelet aggregation, and reduces formation of both arterial and venous thrombi. In a recent, large, well-controlled trial (CAPRIE), clopidogrel has been shown to be superior to aspirin in terms of prevention of ischaemic stroke, myocardial infarction and death in patients with atherosclerotic vascular disease. Clopidogrel provides a safe opportunity to enhance reperfusion when administered during stent placement, by protecting platelets from excessive activation. However, the ability of clopidogrel to be superior to ticlopidine in terms of its antiplatelet properties in the clinical setting of coronary stenting, is unknown. The effects of clopidogrel versus ticlopidine on platelet and endothelial function are yet to be determined and may strongly affect the outcome, benefits, and complications following coronary stent placement. Further clinical trials, well-designed, and carefully conducted, should elucidate possible benefits of clopidogrel during coronary interventions, especially in conjunction with new and aggressive reperfusion techniques. The benefits of clopidogrel in an expanding array of clinical conditions, including myocardial infarction, may be directly related to platelet inhibition. Moreover, marginal clinical benefits, and recently reported severe bleeding events in some patients after oral platelet glycoprotein IIb/IIIa therapy, may advance clopidogrel as a safe, and efficient alternative during coronary interventions. This review summarises the latest, and often confusing data on the effects of thienopyridines on certain haemostatic characteristics in interventional cardiology. 1999 Academic Press.
噻氯匹定已成为治疗中风患者以及冠心病患者支架置入术中的常用疗法。氯吡格雷是另一种噻吩并吡啶类药物，是一种安全且有前景的替代药物，它能不可逆地抑制二磷酸腺苷（ADP）诱导的血小板聚集，并减少动脉和静脉血栓的形成。在最近一项大型、严格对照的试验（氯吡格雷用于预防缺血性事件研究，CAPRIE）中，已表明氯吡格雷在预防动脉粥样硬化性血管疾病患者的缺血性中风、心肌梗死和死亡方面优于阿司匹林。在支架置入过程中给予氯吡格雷时，它通过保护血小板避免过度激活，为增强再灌注提供了一个安全的机会。然而，在冠状动脉支架置入的临床环境中，氯吡格雷在抗血小板特性方面是否优于噻氯匹定尚不清楚。氯吡格雷与噻氯匹定对血小板和内皮功能的影响尚未确定，可能会强烈影响冠状动脉支架置入后的结果、益处和并发症。精心设计和认真实施的进一步临床试验应阐明氯吡格雷在冠状动脉介入治疗期间可能的益处，特别是与新的积极再灌注技术联合使用时。氯吡格雷在包括心肌梗死在内的一系列不断扩大的临床病症中的益处可能直接与血小板抑制有关。此外，口服血小板糖蛋白IIb/IIIa治疗后部分患者出现的边际临床益处以及最近报道的严重出血事件，可能会使氯吡格雷成为冠状动脉介入治疗期间一种安全有效的替代药物。本综述总结了关于噻吩并吡啶类药物对介入心脏病学中某些止血特性影响的最新且常常令人困惑的数据。1999年学术出版社。
