Lenk Ekaterina, Spannagl Michael
Verum Diagnostica GmbH, Roche Professional Diagnostics , Munich, Germany.
Haemostaseologische Ambulanz Campus Innenstadt, Klinikum der Universität München, Ludwig-Maximilians-Universität München, Germany.
EJIFCC. 2013 Feb 21;24(3):90-6. eCollection 2013 Feb.
Cardiovascular diseases are the leading cause of death in the Western world. Several factors have led to the increase in vascular disorders, including the aging population, unhealthy lifestyles, increasing rates of diabetes and raised lipids, and further risk factors resulting in inflammation and calcification of the vascular endothelium. Activated platelets in damaged blood vessels can trigger arterial thrombus formation, leading to vascular occlusion with subsequent organ hypoperfusion and clinical manifestation of myocardial infarction, stroke, or peripheral artery disease. Platelet inhibitors such as aspirin and clopidogrel (Plavix(®) and generics) are prescribed as primary or secondary prevention to attenuate chronic platelet activation. However, a significant proportion of patients do not respond adequately to uniform antiplatelet treatment. These 'non-responders' have an increased risk for stent thrombosis, stroke, and other ischemic complications. Platelet function (PF) tests can identify these patients thus enabling physicians to offer personalized and alternative treatment strategies. Recent alternatives to clopidogrel include prasugrel (Efient(®)) and ticagrelor (Brilique(®)) - that are both more potent than clopidogrel but also more expensive and associated with a higher risk of bleeding complications. Given these drawbacks, PF testing might help clinicians to prescribe optimal antiplatelet agent to maximize patient safety and efficacy while minimizing costs. While randomized studies using different test systems have left clinicians puzzled about the medical value of tailored antiplatelet therapy, accumulated evidence from recent studies on tailored antiplatelet therapies and the association with improved outcomes have now resulted in a consensus expert opinion for the specific adoption of PF diagnostics into clinical practice.
心血管疾病是西方世界的主要死因。多种因素导致血管疾病增加，包括人口老龄化、不健康的生活方式、糖尿病和血脂升高的发病率上升，以及导致血管内皮炎症和钙化的其他危险因素。受损血管中活化的血小板可触发动脉血栓形成，导致血管阻塞，随后出现器官灌注不足以及心肌梗死、中风或外周动脉疾病的临床表现。阿司匹林和氯吡格雷（波立维®及通用名药物）等血小板抑制剂被用作一级或二级预防药物，以减轻慢性血小板活化。然而，相当一部分患者对统一的抗血小板治疗反应不佳。这些“无反应者”发生支架血栓形成、中风和其他缺血性并发症的风险增加。血小板功能（PF）检测可以识别这些患者，从而使医生能够提供个性化的替代治疗策略。氯吡格雷的近期替代药物包括普拉格雷（Efient®）和替格瑞洛（Brilique®），这两种药物都比氯吡格雷更有效，但也更昂贵，且出血并发症风险更高。鉴于这些缺点，PF检测可能有助于临床医生开出最佳的抗血小板药物，在将成本降至最低的同时，最大限度地提高患者的安全性和疗效。虽然使用不同检测系统的随机研究让临床医生对个性化抗血小板治疗的医学价值感到困惑，但近期关于个性化抗血小板治疗及其与改善预后相关性的研究积累的证据，现已形成了将PF诊断具体应用于临床实践的专家共识意见。
