Bonvini Robert F, Reny Jean-Luc, Mach François, Zeller Thomas, Fontana Pierre
Angiology Division, Heart Center, Bad Krozingen, Germany.
Curr Vasc Pharmacol. 2009 Apr;7(2):198-208. doi: 10.2174/157016109787455662.
Cardiovascular diseases are the most common cause of mortality and morbidity accounting for more than 40% of total mortality in Western countries, most of which is due to acute coronary syndromes (ACS), including ST and non-ST elevation myocardial infarction. An optimal pharmacological approach in these patients is of major importance with a particular emphasis on the antiplatelet regimen, which remains the cornerstone of the initial ACS treatment at hospital admission and during percutaneous coronary interventions (PCI). This review briefly discusses the pathogenesis of ACS, and updates the available pharmacological antithrombotic strategies with a particular focus on aspirin and clopidogrel resistance, which has caused major concern, especially in the modern era of interventional cardiology. Persistent platelet reactivity despite aspirin or clopidogrel intake is probably a risk factor for the recurrence of ischemic events. Despite a lack of uniformly accepted definitions of aspirin and clopidogrel resistance, we provide an objective description of what is already proved and what remains to be established. In clopidogrel poor-responders, preliminary data suggest that increasing the loading dose might be beneficial prior to PCI, while trials on the potential benefit of an increased maintenance dose after PCI are ongoing. Overall, data on the mechanisms and the management of platelet hyperactivity or antiplatelet drug biological resistance are still scarce and further studies are needed.
心血管疾病是导致死亡和发病的最常见原因，在西方国家占总死亡率的40%以上，其中大部分是由于急性冠状动脉综合征（ACS），包括ST段抬高型和非ST段抬高型心肌梗死。对这些患者采用最佳的药物治疗方法至关重要，尤其要重视抗血小板治疗方案，这仍然是入院时及经皮冠状动脉介入治疗（PCI）期间初始ACS治疗的基石。本综述简要讨论了ACS的发病机制，并更新了现有的药物抗栓策略，特别关注阿司匹林和氯吡格雷抵抗，这已引起了广泛关注，尤其是在现代介入心脏病学时代。尽管服用了阿司匹林或氯吡格雷，但血小板持续反应性可能是缺血事件复发的危险因素。尽管缺乏对阿司匹林和氯吡格雷抵抗的统一公认定义，但我们对已被证实的和有待确定的内容进行了客观描述。在氯吡格雷反应不佳的患者中，初步数据表明，在PCI前增加负荷剂量可能有益，而关于PCI后增加维持剂量潜在益处的试验正在进行中。总体而言，关于血小板活性过高或抗血小板药物生物抵抗的机制和管理的数据仍然很少，需要进一步研究。
