Department of Clinical and Experimental Medicine, Regional Reference Centre for Coagulation Disorders, 'Federico II' University, Naples, Italy.
Ann Med. 2011 Nov;43(7):531-44. doi: 10.3109/07853890.2011.582137. Epub 2011 Aug 5.
Platelets play a central role in the pathophysiology of atherothrombosis, an inappropriate platelet activation leading to acute ischemic complications (acute myocardial infarction, ischemic stroke). In view of this, platelets are a major target for pharmacotherapy. Presently, the main classes of antiplatelet agents approved for the use in such complications are aspirin and thienopyridines. Although antiplatelet treatment with these two types of drugs, alone or in combination, leads to a significant reduction of non-fatal myocardial infarction (-32%), non-fatal stroke (-25%), and of cardiovascular death (-17%), a residual risk persists. Newer antiplatelet agents have addressed some, but not all, these limitations. Vis-à-vis their net clinical benefit, the higher potency of some of them is associated with a rise in bleeding complications. Moreover, newer thienopyridines do not show advantages over and above the older ones as to reduction of stroke. A concerted effort that takes into consideration clinical, genetic, and laboratory information is increasingly recognized as a major direction to be pursued in the area. The well-established road signs of clinical epidemiology will provide major information to define newer potentially useful targets for platelet pharmacology.
血小板在动脉血栓形成的病理生理学中起着核心作用，血小板的异常激活可导致急性缺血性并发症（急性心肌梗死、缺血性中风）。鉴于此，血小板是药物治疗的主要靶点。目前，批准用于此类并发症的主要抗血小板药物类别为阿司匹林和噻吩吡啶类药物。尽管使用这两种类型的药物单独或联合进行抗血小板治疗可显著降低非致死性心肌梗死（-32%）、非致死性中风（-25%）和心血管死亡（-17%）的风险，但仍存在残余风险。新型抗血小板药物针对其中的一些但不是全部局限性。与它们的净临床获益相比，其中一些药物的更高效力与出血并发症的增加相关。此外，新型噻吩吡啶类药物在降低中风方面并不优于旧的噻吩吡啶类药物。人们越来越认识到，需要共同努力，综合考虑临床、遗传和实验室信息，这是该领域的一个主要发展方向。经过充分验证的临床流行病学路标将提供重要信息，以确定血小板药理学的新的潜在有用靶点。
