Unità di Medicina 3, Ospedale San Paolo, Dipartimento di Medicina, Chirurgia e Odontoiatria, Università degli Studi di Milano, Milano, Italy.
Hematology Am Soc Hematol Educ Program. 2011;2011:70-5. doi: 10.1182/asheducation-2011.1.70.
Interindividual variability in the pharmacological response to antiplatelet drugs has been reported in some studies. Suboptimal response to aspirin, as determined by specific tests (serum thromboxane B(2)), appears to be rare and in most cases is caused by poor compliance. In contrast, studies using specific tests to measure the pharmacological effect of clopidogrel showed a wide variability of responses, with a significant number of subjects (approximately one-third) who were very poor responders. Interindividual differences in the extent of metabolism of clopidogrel to its active metabolite is the most plausible mechanism for the observed interindividual variability in platelet inhibition. Tailored treatment based on laboratory monitoring of platelet function has been proposed as a solution to poor responsiveness to clopidogrel. However, we still need to identify the ideal laboratory test and to answer basic questions on its clinical utility and cost-effectiveness before monitoring clopidogrel therapy can be recommended in clinical practice.
一些研究报道了抗血小板药物的药理反应在个体间存在差异。通过特定的测试（血清血栓素 B2）来确定阿司匹林的反应不理想，这种情况似乎很少见，而且在大多数情况下是由于依从性差所致。相比之下，使用特定测试来测量氯吡格雷的药理作用的研究表明，反应存在广泛的变异性，有相当数量（约三分之一）的患者是非常差的反应者。氯吡格雷向其活性代谢物代谢程度的个体间差异是观察到血小板抑制的个体间变异性的最合理机制。基于实验室监测血小板功能的个体化治疗已被提出作为解决氯吡格雷反应不佳的方法。然而，在推荐临床实践中监测氯吡格雷治疗之前，我们仍需确定理想的实验室检测方法，并回答关于其临床实用性和成本效益的基本问题。
