South Australian Health and Medical Research Institute, Flinders University and Medical Centre, Adelaide, Australia.
Clin Ther. 2013 Aug;35(8):1064-8. doi: 10.1016/j.clinthera.2013.07.429.
Dual antiplatelet therapy is a guideline mandated for patients with acute coronary syndromes (ACS). Despite its use, thrombotic events continue to occur both early and late. Platelet function testing has been used to define the in vitro effects of new antiplatelet agents, and it has been suggested that it be used to choose therapy. The role of platelet function testing, particularly with newer antiplatelet agents, remains unclear.
We review the rationale for platelet function testing and its application in monitoring patients on antiplatelet therapy. We also review recent clinical trials of newer antiplatelet agents. On the basis of this review, we reach conclusions on the current role of antiplatelet function testing in monitoring modern antiplatelet therapy and the role of the new antiplatelet agents in the treatment of ACS.
We reviewed recent publications on platelet function testing and clinical trials of newer antiplatelet therapies compared with clopidogrel.
Platelet function testing is complex, but there is now a bedside test, VerifyNow. High platelet reactivity has been associated with worse cardiovascular outcomes in patients undergoing percutaneous coronary intervention. Recent clinical trials have not found any advantage in outcomes in patients who have their therapy adjusted by monitoring their platelet function. Newer agents, prasugrel, ticagrelor, and cangrelor, produce more rapid, complete, less variable effects on platelet function than clopidogrel. Prasugrel was found to improve outcomes compared with clopidogrel in patients with ACS undergoing percutaneous intervention. Ticagrelor is beneficial in all patients with ACS and reduces cardiovascular mortality compared with clopidogrel. Cangrelor improves outcomes in patients undergoing stenting. Recent studies to assess the role of platelet function monitoring of the effects of clopidogrel and modifying treatments have not been successful.
Recent clinical trials have indicated that newer antiplatelet agents have advantages over clopidogrel in the treatment of ACS. Platelet function testing gives us a guide to the timing, efficacy, and variability of therapy and can correlate with poor patient outcomes; however, the use of antiplatelet function testing to tailor therapy does not seem appropriate.
双联抗血小板治疗是急性冠脉综合征（ACS）患者的指南规定。尽管已经使用了双联抗血小板治疗，但血栓形成事件仍在早期和晚期发生。血小板功能检测已用于定义新型抗血小板药物的体外作用，并已建议将其用于选择治疗方法。血小板功能检测的作用，特别是对于新型抗血小板药物，仍然不清楚。
我们回顾了血小板功能检测的原理及其在监测抗血小板治疗患者中的应用。我们还回顾了新型抗血小板药物的最新临床试验。在此基础上，我们得出了关于目前监测现代抗血小板治疗中抗血小板功能检测的作用以及新型抗血小板药物在 ACS 治疗中的作用的结论。
我们回顾了最近关于血小板功能检测和新型抗血小板治疗与氯吡格雷比较的临床试验的出版物。
血小板功能检测很复杂，但现在有了一种床边检测方法，即 VerifyNow。高血小板反应性与接受经皮冠状动脉介入治疗的患者心血管结局恶化相关。最近的临床试验并没有发现任何证据表明通过监测血小板功能调整治疗可以改善患者的结局。新型药物普拉格雷、替格瑞洛和坎格瑞洛比氯吡格雷更能快速、完全、更一致地影响血小板功能。普拉格雷在接受经皮介入治疗的 ACS 患者中比氯吡格雷改善了结局。替格瑞洛在所有 ACS 患者中均有益，并降低了与氯吡格雷相比的心血管死亡率。坎格瑞洛在接受支架治疗的患者中改善了结局。最近评估氯吡格雷和调整治疗效果的血小板功能监测作用的研究并未成功。
最近的临床试验表明，新型抗血小板药物在 ACS 的治疗中优于氯吡格雷。血小板功能检测为我们提供了治疗时机、疗效和变异性的指导，可以与患者预后不良相关；然而，使用抗血小板功能检测来调整治疗似乎并不合适。
