Mason Peter J, Jacobs Alice K, Freedman Jane E
Whitaker Cardiovascular Institute and Evans Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA.
J Am Coll Cardiol. 2005 Sep 20;46(6):986-93. doi: 10.1016/j.jacc.2004.08.070.
Acute coronary syndromes and other manifestations of atherothrombotic disease are primarily caused by atherosclerotic plaque rupture or fissuring and subsequent occlusive or subocclusive thrombus formation. Platelets play a critical role in the pathophysiology of atherothrombotic disease, and aspirin is the most commonly used antiplatelet agent. Clinical trials have demonstrated the efficacy of aspirin in both primary and secondary prevention of myocardial infarction, stroke, and cardiovascular death. Despite its proven benefit, the absolute risk of recurrent vascular events among patients taking aspirin remains relatively high, an estimated 8% to 18% after two years. Therapeutic resistance to aspirin might explain a portion of this risk. Although formal diagnostic criteria and a validated method of measurement are lacking, aspirin resistance may affect between 5% and 45% of the population. Given the prevalence of cardiovascular disease, the potential impact of aspirin resistance is large. Currently, however, there are many unanswered questions regarding the biological mechanism, diagnosis, population prevalence, clinical relevance, and optimal therapeutic intervention for aspirin resistance.
急性冠状动脉综合征及动脉粥样硬化血栓形成疾病的其他表现主要由动脉粥样硬化斑块破裂或裂隙以及随后的闭塞性或亚闭塞性血栓形成所致。血小板在动脉粥样硬化血栓形成疾病的病理生理学中起关键作用，而阿司匹林是最常用的抗血小板药物。临床试验已证明阿司匹林在心肌梗死、中风及心血管死亡的一级和二级预防中均有效。尽管其益处已得到证实，但服用阿司匹林的患者中复发性血管事件的绝对风险仍然相对较高，两年后的估计风险为8%至18%。对阿司匹林的治疗抵抗可能解释了部分此类风险。尽管缺乏正式的诊断标准和经过验证的测量方法，但阿司匹林抵抗可能影响5%至45%的人群。鉴于心血管疾病的患病率，阿司匹林抵抗的潜在影响很大。然而，目前关于阿司匹林抵抗的生物学机制、诊断、人群患病率、临床相关性及最佳治疗干预仍有许多未解决的问题。
