Cardiovascular Institute, Azienda Ospedaliero-Universitaria Sant'Anna, Ferrara, Italy.
Rev Cardiovasc Med. 2011;12 Suppl 1:S14-22.
Antiplatelet therapy is the cornerstone of treatment for patients with acute coronary syndromes and in those who are undergoing percutaneous coronary intervention (PCI). Clopidogrel, a second-generation thienopyridine antiplatelet agent, is currently used to prevent vascular complications in atherothrombotic patients, to prevent stent thrombosis in patients undergoing PCI, and in the long-term prevention of cardiovascular and cerebrovascular events. Unfortunately, despite treatment with clopidogrel, some patients continue to have cardiovascular events. This may be due in part to a suboptimal response to the drug, with minimal inhibition of platelet aggregation and/or high on-treatment platelet reactivity. Point-of-care testing of clopidogrel response, together with a reliable diagnostic cutoff, can identify patients with high on-treatment platelet reactivity and optimize their clinical management. This article reviews the impact of poor clopidogrel responsiveness on clinical outcomes, the major clinical studies using VerifyNow P2Y12 Assay® (Accumetrics, San Diego, CA) to assess on-clopidogrel platelet reactivity, and efforts to determine a reliable cutoff.
抗血小板治疗是急性冠状动脉综合征患者和经皮冠状动脉介入治疗（PCI）患者的治疗基石。氯吡格雷是一种第二代噻吩吡啶类抗血小板药物，目前用于预防动脉粥样硬化血栓形成患者的血管并发症、预防 PCI 患者的支架血栓形成以及长期预防心血管和脑血管事件。不幸的是，尽管使用了氯吡格雷，一些患者仍继续发生心血管事件。这可能部分归因于对药物的反应不理想，血小板聚集的抑制作用最小化和/或治疗中的血小板反应性高。即时检测氯吡格雷反应，结合可靠的诊断截止值，可以识别出治疗中血小板反应性高的患者，并优化其临床管理。本文综述了氯吡格雷反应不良对临床结局的影响、使用 VerifyNow P2Y12 检测（Accumetrics，圣地亚哥，CA）评估氯吡格雷治疗中血小板反应性的主要临床研究，以及确定可靠截止值的努力。
