Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig-Maximilians-Universität München, Campus Grosshadern, Marchioninistr. 15, 81377 Munich, Germany.
J Cardiovasc Transl Res. 2013 Jun;6(3):371-7. doi: 10.1007/s12265-013-9450-7. Epub 2013 Feb 9.
In patients with an acute coronary syndrome (ACS), inhibition of the platelet P2Y12 receptor is standard of care. The shortcomings of the most commonly used P2Y12 receptor inhibitor clopidogrel-that is its delayed onset of action, its interindividual response variability, and the phenomenon of high on-treatment platelet reactivity-led to the development of more potent P2Y12 receptor inhibitors (prasugrel and ticagrelor) that proved their superiority in terms of reducing thrombotic events compared to clopidogrel. Available randomized studies that aimed at investigating the value of a personalized antiplatelet treatment regimen based on platelet function monitoring results were negative with regard to the possible benefits of monitoring but were all limited by mainly enrolling elective and stable patients with coronary artery disease. Thus, it still warrants further investigation if a tailored, platelet function guided, antiplatelet therapy in ACS patients with the available P2Y12 receptor inhibitors prasugrel, ticagrelor, and clopidogrel can lead to improved patients outcome.
在急性冠状动脉综合征（ACS）患者中，血小板 P2Y12 受体抑制剂的抑制是标准的治疗方法。最常用的 P2Y12 受体抑制剂氯吡格雷存在一些缺点，包括作用起效慢、个体间反应变异性大以及高反应性血小板治疗现象，这导致了更有效的 P2Y12 受体抑制剂（普拉格雷和替格瑞洛）的发展，这些药物在减少血栓事件方面被证明优于氯吡格雷。已有的旨在研究基于血小板功能监测结果的个体化抗血小板治疗方案价值的随机研究结果对监测的可能益处持否定态度，但这些研究都受到主要招募选择性和稳定的冠心病患者的限制。因此，如果使用现有的 P2Y12 受体抑制剂普拉格雷、替格瑞洛和氯吡格雷，针对 ACS 患者进行个体化、基于血小板功能的抗血小板治疗，是否能改善患者的预后，仍需要进一步研究。
