Angiolillo Dominick J, Suryadevara Siva, Capranzano Piera, Zenni Martin Z, Guzman Luis A, Bass Theodore A
Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida 32209, USA.
Catheter Cardiovasc Interv. 2009 Jan 1;73(1):1-14. doi: 10.1002/ccd.21782.
Antiplatelet therapy is the cornerstone of treatment for patients with acute coronary syndrome and is also of particular importance in those who undergo percutaneous coronary intervention with stent implantation. Dual antiplatelet therapy with aspirin and clopidogrel is associated with improvement in long-term clinical outcomes in such patients and is presently the antiplatelet therapy of choice for secondary prevention of thrombotic events. However, a significant number of patients experience recurrent events despite antiplatelet therapy. Although poor patient compliance can account for some of these events, particularly in those patients who receive a drug-eluting stent, increasing evidence indicates that there is variability in response to antiplatelet therapy and patients who have higher levels of platelet reactivity are at increased risk for recurrent ischemic events. However, the lack of a consistent definition of inadequate platelet response, as well as the lack of a standardized measurement technique, has made it difficult to define how to treat these patients. To translate findings associated with variability in platelet response into improved patient care, it is necessary to gain a better understanding of what variable platelet response is, how it is measured, who it should be measured in, and what its clinical relevance is. The objective of this review is to evaluate the data regarding interindividual response variability to antiplatelet therapy with the aim of providing practical considerations and where possible, recommendations, regarding this topic for interventional cardiologists.
抗血小板治疗是急性冠状动脉综合征患者治疗的基石，对于接受冠状动脉支架植入术的经皮冠状动脉介入治疗患者也尤为重要。阿司匹林和氯吡格雷联合抗血小板治疗可改善此类患者的长期临床预后，目前是预防血栓形成事件二级预防的首选抗血小板治疗方法。然而，尽管进行了抗血小板治疗，仍有相当数量的患者发生复发性事件。虽然患者依从性差可解释其中一些事件，尤其是在接受药物洗脱支架的患者中，但越来越多的证据表明，抗血小板治疗的反应存在变异性，血小板反应性较高的患者发生复发性缺血事件的风险增加。然而，由于缺乏对血小板反应不足的一致定义以及标准化的测量技术，难以确定如何治疗这些患者。为了将与血小板反应变异性相关的研究结果转化为更好的患者护理，有必要更好地了解什么是可变血小板反应、如何测量、应在哪些人群中测量以及其临床相关性是什么。本综述的目的是评估关于抗血小板治疗个体间反应变异性的数据，旨在为介入心脏病学家提供关于该主题的实际考虑因素，并在可能的情况下提供建议。
