Department of Cardiology, Institut National de la Santè et de la Recherche Médicale Unité Mixte de Recherche 608, Hôpital Universitaire Nord, Faculté de Médecine, Marseille, France.
J Am Coll Cardiol. 2010 Sep 14;56(12):919-33. doi: 10.1016/j.jacc.2010.04.047.
The addition of clopidogrel to aspirin treatment reduces ischemic events in a wide range of patients with cardiovascular disease. However, recurrent ischemic event occurrence during dual antiplatelet therapy, including stent thrombosis, remains a major concern. Platelet function measurements during clopidogrel treatment demonstrated a variable and overall modest level of P2Y(12) inhibition. High on-treatment platelet reactivity to adenosine diphosphate (ADP) was observed in selected patients. Multiple studies have now demonstrated a clear association between high on-treatment platelet reactivity to ADP measured by multiple methods and adverse clinical event occurrence. However, the routine measurement of platelet reactivity has not been widely implemented and recommended in the guidelines. Reasons for the latter include: 1) a lack of consensus on the optimal method to quantify high on-treatment platelet reactivity and the cutoff value associated with clinical risk; and 2) limited data to support that alteration of therapy based on platelet function measurements actually improves outcomes. This review provides a consensus opinion on the definition of high on-treatment platelet reactivity to ADP based on various methods reported in the literature and proposes how this measurement may be used in the future care of patients.
氯吡格雷联合阿司匹林治疗可降低多种心血管疾病患者的缺血事件。然而，双联抗血小板治疗期间（包括支架内血栓形成）的复发性缺血事件仍然是一个主要关注点。氯吡格雷治疗期间的血小板功能测量显示 P2Y（12）抑制的水平存在变异性且总体较为适度。在选定的患者中观察到对二磷酸腺苷（ADP）的高治疗后血小板反应性。多项研究现已表明，通过多种方法测量的 ADP 高治疗后血小板反应性与不良临床事件的发生之间存在明确关联。然而，血小板反应性的常规测量尚未在指南中广泛实施和推荐。其原因包括：1）缺乏关于量化高治疗后血小板反应性的最佳方法和与临床风险相关的临界值的共识；2）支持基于血小板功能测量改变治疗实际上可改善结局的数据有限。这篇综述根据文献中报道的各种方法，对 ADP 的高治疗后血小板反应性的定义达成了共识意见，并提出了未来如何在患者的治疗中使用这种测量方法。
