INSERM U-698, Université Paris-Diderot, Assistance Publique-Hôpitaux de Paris, Paris, France.
J Thromb Haemost. 2011 Jul;9 Suppl 1:325-32. doi: 10.1111/j.1538-7836.2011.04277.x.
Atherothrombosis remains a major global public health problem. Chronic atherosclerotic disease is often clinically silent and coexists across vascular beds, but when complicated by thrombosis can result in acute coronary syndrome, stroke, transient ischaemic attack and critical limb ischaemia. Platelets play a role in the development of chronic atherosclerotic disease and are a key mediator of clinical events in atherothrombosis. Numerous trials have examined the role of antiplatelet agents in primary and secondary prevention and several new antiplatelet drugs are under development. In secondary prevention, there is evidence of clear benefit of single and in some cases dual antiplatelet therapy in the prevention of recurrent cerebro-vascular complications. Dual antiplatelet therapy has emerged as the standard of care in acute coronary syndromes, with aspirin typically being used in combination with clopidogrel or one of the newer more potent antiplatelet agents. Conversely, in chronic stable coronary disease, no benefit has yet been convincingly demonstrated from dual antiplatelet therapy. In cerebro-vascular disease, aspirin monotherapy remains the cornerstone of prevention of recurrent events, with clopidogrel or the combination of aspirin and dipyridamole being only modestly more efficacious. In primary prevention, the evidence for the routine use of aspirin or any other antiplatelet agent is mixed and suggests this should only be considered on an individual basis in high-risk groups where the thrombotic risk outweighs the risk of major bleeding complications.
动脉粥样硬化血栓形成仍然是一个重大的全球公共卫生问题。慢性动脉粥样硬化性疾病通常在临床上没有症状，且同时存在于多个血管床中，但当它并发血栓形成时，可能导致急性冠状动脉综合征、中风、短暂性脑缺血发作和严重肢体缺血。血小板在慢性动脉粥样硬化性疾病的发展中起作用，是动脉粥样硬化血栓形成中临床事件的关键介导者。许多试验已经研究了抗血小板药物在一级和二级预防中的作用，并且几种新的抗血小板药物正在开发中。在二级预防中，有证据表明，在预防复发性脑血管并发症方面，单一和在某些情况下双重抗血小板治疗具有明确的益处。双重抗血小板治疗已成为急性冠状动脉综合征的标准治疗方法，通常使用阿司匹林与氯吡格雷或一种新型、更有效的抗血小板药物联合使用。相反，在慢性稳定型冠心病中，尚未令人信服地证明双重抗血小板治疗有获益。在脑血管疾病中，阿司匹林单药治疗仍然是预防复发事件的基石，氯吡格雷或阿司匹林和双嘧达莫联合使用仅略微更有效。在一级预防中，常规使用阿司匹林或任何其他抗血小板药物的证据存在差异，表明仅应在血栓形成风险超过大出血并发症风险的高危人群中，根据个体情况考虑使用。
