Duerschmied Daniel, Bode Christoph, Moser Martin
University Hospital of Freiburg, Department of Cardiology and Angiology, Hugstetter Str. 55, 79106 Freiburg, Germany.
Expert Rev Cardiovasc Ther. 2010 Sep;8(9):1215-29. doi: 10.1586/erc.10.104.
The platelet ADP receptor antagonist clopidogrel is recommended for the treatment of patients with acute coronary syndrome and/or percutaneous coronary intervention. Patients who received a coronary stent in particular should be protected by sufficient antiplatelet therapy to prevent stent thrombosis. Clopidogrel is a prodrug and has to undergo extensive metabolization before the active metabolite can irreversibly bind to platelets. This makes clopidogrel treatment susceptible to genetic and drug interactions. Recent study findings suggest that initial treatment with a higher dose of clopidogrel may be superior to the currently approved dose. It is not clear whether this approach will be sufficient to entirely overcome clopidogrel hyporesponsiveness, which worsens outcomes in up to one-third of patients. Newer antiplatelet agents are emerging but clopidogrel remains the best established treatment option, with more than 120,000 patients treated in randomized trials and 12 years of clinical postmarketing experience.
血小板 ADP 受体拮抗剂氯吡格雷被推荐用于治疗急性冠脉综合征和/或经皮冠状动脉介入治疗的患者。特别是接受冠状动脉支架植入术的患者，应接受充分的抗血小板治疗以预防支架血栓形成。氯吡格雷是一种前体药物，必须经过广泛代谢才能使活性代谢产物不可逆地与血小板结合。这使得氯吡格雷治疗易受遗传和药物相互作用的影响。最近的研究结果表明，初始使用较高剂量的氯吡格雷治疗可能优于目前批准的剂量。目前尚不清楚这种方法是否足以完全克服氯吡格雷低反应性，在高达三分之一的患者中，氯吡格雷低反应性会使预后恶化。新型抗血小板药物不断涌现，但氯吡格雷仍然是最成熟的治疗选择，在随机试验中有超过 120,000 名患者接受治疗，并有 12 年的上市后临床经验。
