Gurbel Paul A, Tantry Udaya S
Sinai Center for Thrombosis Research, Baltimore, Maryland 21215, USA.
J Interv Cardiol. 2006 Oct;19(5):439-48. doi: 10.1111/j.1540-8183.2006.00181.x.
The efficacy with aspirin and clopidogrel treatment has been demonstrated in various clinical trials. Laboratory evaluation of platelet response in recent studies revealed that a distinctive response variability and nonresponsiveness/resistance in selected patients were associated with these antiplatelet agents. Moreover, some studies have correlated this nonresponsiveness/resistance phenomenon to the occurrence of thrombotic events. At this time there are no uniformly established methods to quantify exvivo platelet reactivity after clopidogrel and aspirin treatment of the extent of platelet inhibition by clopidogrel and aspirin. Therefore, specific treatment recommendations for patients exhibiting high platelet reactivity or poor platelet inhibition during clopidogrel or aspirin therapy are not established. A higher aspirin dose and strict compliance to therapy may overcome the occurrence of "aspirin resistance" in selected patients. A higher clopidogrel dose may be considered in patients exhibiting clopidogrel nonresponsiveness.
阿司匹林和氯吡格雷治疗的疗效已在各种临床试验中得到证实。近期研究对血小板反应进行的实验室评估显示，在部分患者中，这些抗血小板药物存在明显的反应变异性以及无反应性/抵抗性。此外，一些研究已将这种无反应性/抵抗性现象与血栓事件的发生相关联。目前，尚无统一确立的方法来量化氯吡格雷和阿司匹林治疗后体外血小板反应性，以及氯吡格雷和阿司匹林对血小板的抑制程度。因此，对于在氯吡格雷或阿司匹林治疗期间表现出高血小板反应性或血小板抑制不佳的患者，尚未确立具体的治疗建议。较高剂量的阿司匹林以及严格遵守治疗方案可能会克服部分患者中“阿司匹林抵抗”的发生。对于表现出氯吡格雷无反应性的患者，可考虑使用更高剂量的氯吡格雷。
