Steg Gabriel
Bull Acad Natl Med. 2013 Feb;197(2):375-87; discussion 387-8.
Atherothrombosis is a major global public health problem. Chronic atherosclerotic disease is often clinically silent and coexists across multiple vascular beds but, when complicated by thrombosis, it can result in an acute coronary syndrome, stroke, transient ischemic attack, and critical limb ischemia. Platelets play a role in the development of chronic atherosclerotic disease and are a key mediator of clinical events in atherothrombosis. Numerous clinical trials have tested antiplatelet agents for primary and secondary prevention, and several new antiplatelet drugs are under development. There is evidence of clear benefit of single and, in some cases, dual antiplatelet therapy in the prevention of recurrent cardiovascular and cerebrovascular complications. Dual antiplatelet therapy has emerged as the standard of care for acute coronary syndromes, with aspirin typically being used in combination with clopidogrel or one of the newer more potent ADP receptor antagonists (ticagrelor or prasugrel). Conversely, in chronic stable coronary disease, no benefit of dual antiplatelet therapy has yet been convincingly demonstrated Evidence supporting routine use of aspirin or any other antiplatelet agent for primary prevention is mixed, and this strategy should only be considered for individual high-risk patients in whom the thrombotic risk outweighs the risk of major bleeding complications.
动脉粥样硬化血栓形成是一个重大的全球公共卫生问题。慢性动脉粥样硬化疾病在临床上通常没有症状，且在多个血管床中并存，但是当并发血栓形成时，它可能导致急性冠状动脉综合征、中风、短暂性脑缺血发作和严重肢体缺血。血小板在慢性动脉粥样硬化疾病的发展中起作用，并且是动脉粥样硬化血栓形成临床事件的关键介质。众多临床试验已经对用于一级和二级预防的抗血小板药物进行了测试，并且有几种新的抗血小板药物正在研发中。有证据表明，单药抗血小板治疗以及在某些情况下的双联抗血小板治疗在预防心血管和脑血管并发症复发方面具有明显益处。双联抗血小板治疗已成为急性冠状动脉综合征的标准治疗方案，通常将阿司匹林与氯吡格雷或一种更新的更强效的ADP受体拮抗剂（替格瑞洛或普拉格雷）联合使用。相反，在慢性稳定型冠心病中，双联抗血小板治疗的益处尚未得到令人信服的证明。支持常规使用阿司匹林或任何其他抗血小板药物进行一级预防的证据不一，并且这种策略仅应考虑用于血栓形成风险超过大出血并发症风险的个体高危患者。
