Jneid Hani, Bhatt Deepak L, Corti Roberto, Badimon Juan J, Fuster Valentin, Francis Gary S
Division of Cardiology, University of Louisville, Louisville, KY, USA.
Arch Intern Med. 2003 May 26;163(10):1145-53. doi: 10.1001/archinte.163.10.1145.
Platelet adhesion, activation, and aggregation are central to thrombus formation, which follows atherosclerotic plaque disruption and causes acute coronary syndromes. Aspirin and clopidogrel exert their antiplatelet effects by inhibiting thromboxane A2 production and adenosine diphosphate-induced platelet aggregation pathways, respectively. Aspirin has proven benefits in primary and secondary prevention of coronary artery disease. Clopidogrel, an alternative antiplatelet agent used in patients with aspirin intolerance, is especially useful in combination with aspirin after coronary stent procedures. The CURE (Clopidogrel in Unstable Angina to Prevent Recurrent Events) study demonstrates for the first time the benefit of adding clopidogrel to aspirin rather than using aspirin alone in patients having acute coronary syndromes without ST-segment elevation myocardial infarction. Patients who are resistant to aspirin (up to 10%) have higher rates of cardiovascular events and may derive special benefit from the combination therapy. Aspirin resistance can be assessed through platelet aggregometry testing, measurement of urinary thromboxane metabolites, and, possibly, genomic testing in the future.
血小板的黏附、活化和聚集是血栓形成的核心环节，血栓形成继发于动脉粥样硬化斑块破裂，并可导致急性冠状动脉综合征。阿司匹林和氯吡格雷分别通过抑制血栓素A2生成和二磷酸腺苷诱导的血小板聚集途径发挥抗血小板作用。阿司匹林已被证实对冠状动脉疾病的一级和二级预防有益。氯吡格雷是用于阿司匹林不耐受患者的一种替代抗血小板药物，在冠状动脉支架置入术后与阿司匹林联合使用尤为有用。CURE（氯吡格雷用于不稳定型心绞痛预防再发事件）研究首次证明，在无ST段抬高型心肌梗死的急性冠状动脉综合征患者中，加用氯吡格雷而非单用阿司匹林有益。对阿司匹林抵抗的患者（高达10%）发生心血管事件的几率更高，联合治疗可能对其有特殊益处。阿司匹林抵抗可通过血小板聚集试验、尿血栓素代谢产物测定进行评估，未来可能还可通过基因检测进行评估。
