Orme Rachel, Judge Heather M, Storey Robert F
Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom.
Semin Thromb Hemost. 2017 Apr;43(3):311-319. doi: 10.1055/s-0036-1597298. Epub 2017 Mar 6.
The increasing use of antiplatelet therapy, particularly aspirin and oral P2Y inhibitors, in the prevention and management of arterial thrombosis, has stimulated extensive pharmacodynamic studies and research into tailored antiplatelet regimens. Many different methodologies have been studied for monitoring antiplatelet drugs and some are now well validated and used in clinical practice. However, clinical studies of tailored antiplatelet therapy have not convincingly demonstrated a benefit of this approach in patients treated with aspirin and clopidogrel, coupled with the fact that more potent antiplatelet therapies have more consistent effects compared with clopidogrel and so may reduce the rationale for monitoring. On the other hand, the optimum timing of urgent surgery after cession of oral antiplatelet therapy may be informed by platelet function testing. This review discusses the different methodologies that have been used to monitor the effects of antiplatelet therapy and highlights the current position of platelet function testing in clinical practice.
抗血小板治疗，尤其是阿司匹林和口服P2Y抑制剂，在动脉血栓形成的预防和管理中的应用日益增加，这激发了广泛的药效学研究以及对定制抗血小板方案的探索。已经研究了许多不同的方法来监测抗血小板药物，其中一些方法现已得到充分验证并应用于临床实践。然而，针对接受阿司匹林和氯吡格雷治疗的患者进行的定制抗血小板治疗的临床研究，并未令人信服地证明这种方法的益处，再加上与氯吡格雷相比，更强效的抗血小板治疗具有更一致的效果，因此可能减少了监测的必要性。另一方面，口服抗血小板治疗中断后紧急手术的最佳时机，可能需要通过血小板功能检测来确定。本综述讨论了用于监测抗血小板治疗效果的不同方法，并强调了血小板功能检测在临床实践中的现状。
