Department of Cardiovascular Sciences, Campus Bio-Medico University, Via E. Longoni, 83, 00155 Rome, Italy.
J Cardiovasc Transl Res. 2013 Jun;6(3):346-54. doi: 10.1007/s12265-012-9439-7. Epub 2013 Jan 3.
Single antiplatelet therapy with aspirin is actually recommended for cardiovascular prevention in patients with stable coronary disease, whereas dual antiplatelet therapy (aspirin and clopidogrel) represents the established treatment in patients with acute coronary syndromes or stable angina undergoing percutaneous coronary intervention. However, recurrent ischemic events occur in patients on treatment with clopidogrel; this may be due to low responsiveness to this agent, a phenomenon influenced by environmental, clinical, and genetic factors. Different strategies have been tested to overcome this phenomenon, such as increase in clopidogrel loading and maintenance doses and use of newer P2Y12 inhibitors (prasugrel and ticagrelor), which are by now indicated for patients with acute coronary syndromes; the latter agents have been associated with stronger antiplatelet effect than clopidogrel even in patients with stable coronary disease, but further studies are needed to test their net clinical benefit in this setting (reduction of ischemic events without increase in bleeding).
在稳定型冠心病患者中，实际上推荐使用阿司匹林进行单一抗血小板治疗，而对于急性冠脉综合征或行经皮冠状动脉介入治疗的稳定型心绞痛患者，双重抗血小板治疗（阿司匹林和氯吡格雷）则是既定的治疗方法。然而，接受氯吡格雷治疗的患者会出现反复的缺血性事件；这可能是由于对该药物的反应性低，这种现象受环境、临床和遗传因素的影响。已经尝试了不同的策略来克服这种现象，例如增加氯吡格雷的负荷剂量和维持剂量以及使用新型 P2Y12 抑制剂（普拉格雷和替格瑞洛），这些药物现在已被用于急性冠脉综合征患者；与氯吡格雷相比，这些药物在稳定型冠心病患者中具有更强的抗血小板作用，但仍需要进一步的研究来检验它们在这种情况下的净临床获益（在不增加出血的情况下减少缺血事件）。
