Jennings Lisa K
Vascular Biology Center of Excellence, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN 38163, USA.
Crit Pathw Cardiol. 2009 Mar;8(1):20-8. doi: 10.1097/HPC.0b013e318194e45e.
Platelet reactivity (eg, platelet adhesion, activation, aggregation) is the underlying pathology for atherothrombotic processes and subsequent ischemic complications. Antiplatelet drugs, including aspirin, dipyridamole, thienopyridines (clopidogrel and ticlopidine), and glycoprotein IIb/IIIa antagonists, have proven efficacy in atherothrombotic event prevention. However, variability of platelet response measured in the laboratory has been reported and is a subject of keen interest.It is unclear to what extent variability of platelet response to antiplatelet agents is associated with clinical outcomes. A better understanding of this issue requires a general consensus for a standard, preferably point-of-care, ex vivo or in vitro assay to determine the effects of antiplatelet agents on key platelet functions. Currently, results using various methods have not yielded an obvious answer. Small-scale studies have examined the correlation between ex vivo inhibition of platelet aggregation or residual platelet activity and clinical endpoints, and although evidence shows that such correlations may exist, results have not been consistent or definitive. Data from large-scale prospective trials are needed to expand our current understanding of the benefits and limitations of utilizing platelet function tests to effectively manage the balance between protection and risks associated with the antiplatelet therapies, aspirin, and clopidogrel.
血小板反应性（如血小板黏附、活化、聚集）是动脉粥样硬化血栓形成过程及后续缺血性并发症的潜在病理机制。抗血小板药物，包括阿司匹林、双嘧达莫、噻吩吡啶类（氯吡格雷和噻氯匹定）以及糖蛋白IIb/IIIa拮抗剂，已被证明在预防动脉粥样硬化血栓形成事件方面有效。然而，实验室检测到的血小板反应变异性已有报道，且备受关注。目前尚不清楚血小板对抗血小板药物反应的变异性在多大程度上与临床结局相关。要更好地理解这个问题，需要就一种标准达成普遍共识，最好是即时检测的体外或离体检测方法，以确定抗血小板药物对关键血小板功能的影响。目前，使用各种方法得到的结果尚未给出明确答案。小规模研究已考察了体外血小板聚集抑制或残余血小板活性与临床终点之间的相关性，尽管有证据表明这种相关性可能存在，但结果并不一致或明确。需要大规模前瞻性试验的数据来扩展我们目前对利用血小板功能检测有效管理抗血小板治疗（阿司匹林和氯吡格雷）相关的保护与风险平衡的益处和局限性的理解。
