Sinai Center for Thrombosis Research, Siani Hospital, 2401 West Belvedere Avenue, Baltimore, MD 21215, USA.
Nat Rev Cardiol. 2011 Jul 19;8(10):572-9. doi: 10.1038/nrcardio.2011.107.
Dual antiplatelet therapy with clopidogrel and aspirin is recommended for the prevention of ischemic events in high-risk patients with coronary artery disease. In patients with atrial fibrillation, oral anticoagulant therapy with warfarin is the 'gold standard' for the prevention of thromboembolism. Nearly 20% of patients with atrial fibrillation also have coronary artery disease and receive combination therapy consisting of dual antiplatelet therapy plus warfarin, also known as triple antithrombotic therapy. Unfortunately, though, increased bleeding risk is a major concern during triple therapy. Whether platelet function testing can guide personalized antiplatelet therapy and reduce ischemic risk is under investigation in large trials of patients treated with coronary artery stents. However, limited data are available to establish the relationship between platelet function testing and bleeding in patients treated with dual or triple therapy. Personalized treatment strategies could help to achieve maximum clinical benefit while avoiding excessive bleeding complications. In this article, we review available data on the utility of platelet function testing in assessing bleeding risk and its potential role in personalizing combination antithrombotic therapies with the aim of reducing ischemic events and the frequency of bleeding.
氯吡格雷和阿司匹林双联抗血小板治疗推荐用于冠心病高危患者预防缺血事件。在心房颤动患者中，华法林口服抗凝治疗是预防血栓栓塞的“金标准”。近 20%的心房颤动患者也有冠状动脉疾病，并接受双联抗血小板治疗加华法林的联合治疗，也称为三联抗血栓治疗。然而，三联治疗期间出血风险增加是一个主要关注点。血小板功能检测是否可以指导个体化抗血小板治疗并降低缺血风险正在接受冠状动脉支架治疗的患者的大型试验中进行研究。然而，关于血小板功能检测与接受双联或三联治疗的患者出血之间的关系，可用的数据有限。个性化治疗策略可以帮助在避免过度出血并发症的同时实现最大的临床获益。在本文中，我们回顾了血小板功能检测在评估出血风险方面的可用数据及其在个体化联合抗血栓治疗中的潜在作用，旨在降低缺血事件和出血频率。
