Lüscher T F, Pfisterer M
Departement Medizin, Abteilung für Kardiologie, Kantonsspital Basel.
Schweiz Rundsch Med Prax. 1990 Sep 25;79(39):1132-41.
An increased platelet-vessel wall interaction plays an important role in most forms of cardiovascular disease. In healthy arteries, the vascular endothelium prevents platelet adhesion and aggregation. As a mediator of this protective function, the endothelium produces prostacyclin, endothelium-derived nitric oxide and tissue plasminogen activator. Cardiovascular risk factors such as hypertension, hyperlipidemia and diabetes are associated with an increased platelet activation and with decreased antithrombotic properties of the blood vessel wall. The available inhibitors of platelet function interfere only with one of various mechanisms of platelet activation and of the platelet-vessel wall interaction. Prostaglandin inhibitors, such as aspirin and newer, more specific inhibitors, prevent the production and/or the effect of thromboxane A2 on platelets and the blood vessel wall. Other drugs interfere with the effect of adenosine diphosphate on platelets, or they increase intracellular concentration of cyclic GMP or AMP in platelets and vascular smooth muscle cells. The protective effects of platelet inhibitors in primary and particularly in secondary prevention of cardiovascular diseases have been documented in numerous studies. The successful clinical use of these substances, however, requires a selective prescription of the drugs in patients with cardiovascular disease.
血小板与血管壁相互作用增强在大多数心血管疾病形式中起重要作用。在健康动脉中，血管内皮可防止血小板黏附和聚集。作为这种保护功能的介质，内皮产生前列环素、内皮衍生的一氧化氮和组织纤溶酶原激活剂。高血压、高脂血症和糖尿病等心血管危险因素与血小板活化增加及血管壁抗血栓特性降低有关。现有的血小板功能抑制剂仅干扰血小板活化及血小板与血管壁相互作用的多种机制之一。前列腺素抑制剂，如阿司匹林及更新的、更具特异性的抑制剂，可防止血栓素A2对血小板和血管壁的产生及/或作用。其他药物干扰二磷酸腺苷对血小板的作用，或增加血小板及血管平滑肌细胞内环鸟苷酸或环磷酸腺苷的浓度。血小板抑制剂在心血管疾病一级预防尤其是二级预防中的保护作用已在众多研究中得到证实。然而，这些药物在临床上的成功应用需要对心血管疾病患者进行选择性用药。
