Bernlochner Isabell, Byrne Robert A, Kastrati Adnan, Sibbing Dirk
Deutsches Herzzentrum München, Lazarettstrasse 36, Munich, Germany.
Expert Rev Cardiovasc Ther. 2011 Aug;9(8):999-1014. doi: 10.1586/erc.11.80.
Dual oral antiplatelet therapy with aspirin and clopidogrel is the therapy of choice in patients with acute coronary syndromes and in patients undergoing coronary stent placement to lower the risk of thrombotic events. Responsiveness to aspirin and especially to clopidogrel is not uniform and is subject to considerable interindividual variability. Furthermore, there is a broad consensus that clopidogrel low response or so-called high on-treatment platelet reactivity is linked to the occurrence of ischemic events. On the other hand, evidence is accumulating that enhanced clopidogrel responders are at increased risk of bleeding. Newer antiplatelet drugs, such as prasugrel and ticagrelor, are more potent and produce more consistent inhibition of platelet aggregation via the P2Y(12) ADP platelet receptor. A variety of methods of platelet function testing are available for evaluating platelet inhibition in percutaneous coronary intervention-treated patients in order to help determine the individual risk for ischemic and bleeding complications. Although not yet routinely undertaken, platelet function testing offers the potential to tailor antiplatelet therapy for individual patients. Whether alteration of therapy based on platelet function testing improves patients' outcomes remains unclear and is currently under investigation. This article reviews the impact of antiplatelet drug responsiveness on clinical outcomes with a focus on P2Y(12) receptor inhibition as well as on current and future concepts for personalized antiplatelet strategies.
阿司匹林和氯吡格雷双重口服抗血小板治疗是急性冠状动脉综合征患者以及接受冠状动脉支架置入术患者降低血栓形成事件风险的首选治疗方法。对阿司匹林尤其是氯吡格雷的反应并不一致，个体间存在很大差异。此外，人们普遍认为氯吡格雷低反应或所谓的治疗时高血小板反应性与缺血事件的发生有关。另一方面，越来越多的证据表明氯吡格雷反应增强的患者出血风险增加。新型抗血小板药物，如普拉格雷和替格瑞洛，效力更强，通过P2Y(12) ADP血小板受体对血小板聚集产生更持续的抑制作用。有多种血小板功能检测方法可用于评估经皮冠状动脉介入治疗患者的血小板抑制情况，以帮助确定缺血和出血并发症的个体风险。虽然尚未常规开展，但血小板功能检测为针对个体患者调整抗血小板治疗提供了可能。基于血小板功能检测改变治疗方案是否能改善患者预后仍不明确，目前正在研究中。本文综述了抗血小板药物反应性对临床结局的影响，重点关注P2Y(12)受体抑制以及个性化抗血小板策略的当前和未来概念。
