From the Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia (P.M., M.C.B); Western Australian Centre for Thrombosis and Haemostasis, Murdoch University, Perth, Western Australia, Australia (R.I.B.); and Australian Centre for Blood Diseases, Department of Clinical Haematology, Monash University, Melbourne, Victoria, Australia (R.K.A.).
Arterioscler Thromb Vasc Biol. 2015 Jun;35(6):1327-38. doi: 10.1161/ATVBAHA.114.303413. Epub 2015 Apr 2.
An unresolved problem with clinical use of antiplatelet therapy is that a significant number of individuals either still get thrombosis or run the risk of life-threatening bleeding. Antiplatelet drugs are widely used clinically, either chronically for people at risk of athero/thrombotic disease or to prevent thrombus formation during surgery. However, a subpopulation may be resistant to standard doses, while the platelet targets of these drugs are also critical for the normal hemostatic function of platelets. In this review, we will briefly examine current antiplatelet therapy and existing targets while focusing on new potential approaches for antiplatelet therapy and improved monitoring of effects on platelet reactivity in individuals, ultimately to improve antithrombosis with minimal bleeding. Primary platelet adhesion-signaling receptors, glycoprotein (GP)Ib-IX-V and GPVI, that bind von Willebrand factor/collagen and other prothrombotic factors are not targeted by drugs in clinical use, but they are of particular interest because of their key role in thrombus formation at pathological shear.
抗血小板治疗在临床应用中存在一个悬而未决的问题，即相当数量的个体仍然存在血栓形成的风险，或者有生命威胁性出血的风险。抗血小板药物在临床上广泛应用，无论是对于有动脉粥样硬化/血栓形成疾病风险的个体进行慢性治疗，还是在手术中预防血栓形成。然而，一部分人群可能对抗血小板药物的标准剂量有抵抗性，而这些药物的血小板靶点对于血小板正常止血功能也很关键。在这篇综述中，我们将简要地检查当前的抗血小板治疗和现有的靶点，同时关注抗血小板治疗的新潜在方法和对个体血小板反应性的效果监测，最终以最小的出血风险实现抗血栓形成。在临床应用中，药物并不针对主要的血小板黏附信号受体，即 GPIb-IX-V 和 GPIb-V，它们与血管性血友病因子/胶原和其他促血栓形成因子结合，但由于它们在病理切变下血栓形成中的关键作用，这些受体引起了特别关注。
