Veterans Affairs Boston Healthcare System, Brigham and Women's Hospital and Harvard Medical School, 1400 VFW Parkway, Boston, MA 02132, USA.
Nat Rev Cardiol. 2010 Aug;7(8):461-7. doi: 10.1038/nrcardio.2010.71. Epub 2010 Jun 1.
A wide range of interindividual variability in the measured and clinical effects of antiplatelet drugs exists. As patients with less platelet inhibition consistently have increased rates of adverse cardiovascular outcomes, a great deal of effort is being focused on understanding and treating this apparent 'resistance.' Pharmacogenomic and pharmacodynamic methods to better delineate responders from nonresponders are being developed, and innovative strategies and novel, potent drugs capable of overcoming nonresponsiveness are in active clinical trials. Less attention has been paid to the confounding role that patient nonadherence has on individual response to antiplatelet therapy, but accruing evidence indicates that nonadherence has a dominant impact in real-world, outpatient settings, as compared with true, biochemical antiplatelet nonresponsiveness. Understanding the mechanisms of nonadherence and rigorously testing methods to overcome it are urgently needed to avoid the potential harm in delivering increasingly intense and expensive therapies to those who may not need it, while at the same time offering a way to improve overall health-care efficiency.
抗血小板药物在测量和临床效果方面存在广泛的个体间差异。由于血小板抑制程度较低的患者心血管不良结局发生率持续增加，因此人们正在努力理解和治疗这种明显的“抵抗”现象。正在开发更好地区分反应者和无反应者的药物基因组学和药效学方法，以及能够克服无反应性的创新策略和新型强效药物正在进行临床试验。人们对患者不依从性对个体抗血小板治疗反应的混淆作用关注较少，但越来越多的证据表明，与真正的生物化学抗血小板无反应性相比，不依从性在现实世界的门诊环境中具有更大的影响。了解不依从的机制并严格测试克服它的方法是非常必要的，以避免将日益强烈和昂贵的治疗方法提供给那些可能不需要的人所带来的潜在危害，同时也提供了一种提高整体医疗保健效率的方法。
