The William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK.
Heart. 2010 Nov;96(21):1693-4. doi: 10.1136/hrt.2010.205724.
Aspirin is now widely accepted as the first-line antithrombotic platelet therapy for at-risk individuals. During the last decade or so it has also become established that co-administering antagonists of the ADP receptor P2Y(12) with aspirin further reduces the risk of acute thrombotic events. By the nature of its evolution, this therapeutic approach assumes that P2Y(12) receptor antagonists will be added to aspirin, and this therefore dominates the design of clinical trials. This strategy has resulted in the generation of a large body of clinical evidence showing the benefit of aspirin plus P2Y(12) receptor antagonists, largely from studies with clopidogrel and more recently from those with prasugrel and ticagrelor, but with obvious limitations in terms of residual ischaemic event rates and bleeding complications. It is our hypothesis, however, that when administered in the presence of potent P2Y(12) receptor antagonists, aspirin could actually increase total cardiovascular risk, although this has never been tested in large outcome studies. Clearly, this potentially negative interaction could be of relevance to millions of patients.
阿司匹林目前被广泛认为是高危人群的一线抗血小板血栓治疗药物。在过去十年左右的时间里，人们还发现，同时使用 ADP 受体 P2Y(12)拮抗剂与阿司匹林联合治疗，可进一步降低急性血栓事件的风险。由于其发展的性质，这种治疗方法假定 P2Y(12)受体拮抗剂将与阿司匹林联合使用，因此这主导了临床试验的设计。这一策略产生了大量的临床证据，表明阿司匹林加 P2Y(12)受体拮抗剂的益处，主要来自于氯吡格雷的研究，最近还有普拉格雷和替格瑞洛的研究，但在残留缺血事件发生率和出血并发症方面存在明显的局限性。然而，我们的假设是，当在强效 P2Y(12)受体拮抗剂存在的情况下使用阿司匹林时，实际上可能会增加心血管的总体风险，尽管这从未在大型结局研究中进行过测试。显然，这种潜在的负面相互作用可能与数百万患者有关。
