Pham Son V, Pham Phuong-Chi T, Pham Phuong-Mai T, Miller Jeffrey M, Pham Phuong-Thu T, Pham Phuong-Anh T
Bay Pines VA Medical Center, Department of Cardiology, Bay Pines, FL, USA.
Drug Des Devel Ther. 2010 Sep 7;4:203-20. doi: 10.2147/DDDT.S12056.
In patients undergoing percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS), both periprocedural acute myocardial infarction and bleeding complications have been shown to be associated with early and late mortality. Current standard antithrombotic therapy after coronary stent implantation consists of lifelong aspirin and clopidogrel for a variable period depending in part on the stent type. Despite its well-established efficacy in reducing cardiac-related death, myocardial infarction, and stroke, dual antiplatelet therapy with aspirin and clopidogrel is not without shortcomings. While clopidogrel may be of little beneficial effect if administered immediately prior to PCI and may even increase major bleeding risk if coronary artery bypass grafting is anticipated, early discontinuation of the drug may result in insufficient antiplatelet coverage with thrombotic complications. Optimal and rapid inhibition of platelet activity to suppress ischemic and thrombotic events while minimizing bleeding complications is an important therapeutic goal in the management of patients undergoing percutaneous coronary intervention. In this article we present an overview of the literature on clinical trials evaluating the different aspects of antithrombotic therapy in patients undergoing PCI and discuss the emerging role of these agents in the contemporary era of early invasive coronary intervention. Clinical trial acronyms and their full names are provided in Table 1.
在接受经皮冠状动脉介入治疗（PCI）的急性冠状动脉综合征（ACS）患者中，围手术期急性心肌梗死和出血并发症均已被证明与早期和晚期死亡率相关。目前冠状动脉支架植入术后的标准抗栓治疗包括终身服用阿司匹林和氯吡格雷，服用时间长短不一，部分取决于支架类型。尽管阿司匹林和氯吡格雷双联抗血小板治疗在降低心脏相关死亡、心肌梗死和中风方面的疗效已得到充分证实，但并非没有缺点。如果在PCI之前立即服用氯吡格雷，其可能几乎没有益处，而且如果预计要进行冠状动脉旁路移植术，甚至可能增加大出血风险，而早期停用该药物可能导致抗血小板覆盖不足并引发血栓并发症。在接受经皮冠状动脉介入治疗的患者管理中，最佳且快速地抑制血小板活性以抑制缺血性和血栓性事件，同时将出血并发症降至最低，是一个重要的治疗目标。在本文中，我们概述了评估PCI患者抗栓治疗不同方面的临床试验文献，并讨论了这些药物在当代早期侵入性冠状动脉介入时代的新作用。表1列出了临床试验的缩写及其全名。
