Angiolillo Dominick J, Fernandez-Ortiz Antonio, Bernardo Esther, Alfonso Fernando, Macaya Carlos, Bass Theodore A, Costa Marco A
Division of Cardiology, University of Florida-Shands Jacksonville, Jacksonville, Florida 32209, USA.
J Am Coll Cardiol. 2007 Apr 10;49(14):1505-16. doi: 10.1016/j.jacc.2006.11.044. Epub 2007 Mar 26.
Antiplatelet therapy is the cornerstone of treatment for patients with acute coronary syndromes and/or undergoing percutaneous coronary interventions. Clopidogrel, in combination with aspirin, is currently the antiplatelet treatment of choice for prevention of stent thrombosis, and clinical trials have shown that, in high-risk patients, prolonged dual antiplatelet treatment is more effective than aspirin alone in preventing major cardiovascular events. However, despite the use of clopidogrel, a considerable number of patients continue to have cardiovascular events. Numerous in vitro studies have shown that individual responsiveness to clopidogrel is not uniform in all patients and is subject to inter- and intraindividual variability. Notably, there is a growing degree of evidence that recurrence of ischemic complications may be attributed to poor response to clopidogrel. The mechanisms leading to poor clopidogrel effects are not fully elucidated and are likely multifactorial. Although the gold standard definition to assess antiplatelet drug response has not been fully established, there is sufficient evidence to support that persistence of enhanced platelet reactivity despite the use of clopidogrel is a clinically relevant entity. This paper reviews the impact of individual response variability to clopidogrel on clinical outcomes and current and future directions for its management.
抗血小板治疗是急性冠状动脉综合征患者和/或接受经皮冠状动脉介入治疗患者治疗的基石。氯吡格雷联合阿司匹林是目前预防支架血栓形成的抗血小板治疗首选，临床试验表明，在高危患者中，延长双联抗血小板治疗在预防主要心血管事件方面比单用阿司匹林更有效。然而，尽管使用了氯吡格雷，仍有相当数量的患者继续发生心血管事件。大量体外研究表明，所有患者对氯吡格雷的个体反应性并不一致，存在个体间和个体内差异。值得注意的是，越来越多的证据表明，缺血性并发症的复发可能归因于对氯吡格雷反应不佳。导致氯吡格雷效果不佳的机制尚未完全阐明，可能是多因素的。尽管评估抗血小板药物反应的金标准定义尚未完全确立，但有足够的证据支持，尽管使用了氯吡格雷，血小板反应性增强仍然持续存在这一情况具有临床相关性。本文综述了氯吡格雷个体反应变异性对临床结局的影响及其管理的现状和未来方向。
