Martin A-C, Houssany-Pissot S, Zlotnik D, Taylor G, Godier A
Service de cardiologie, hôpital d'instruction des armées Percy, 92140 Clamart, France; Inserm UMRS 1140, faculté de pharmacie, université Paris Descartes, 75006 Paris, France.
Service de cardiologie, hôpital d'instruction des armées Percy, 92140 Clamart, France.
Rev Med Interne. 2017 Jul;38(7):467-473. doi: 10.1016/j.revmed.2017.01.013. Epub 2017 May 17.
Like all antithrombotic drugs, antiplatelet agents expose to a risk of bleeding complications. Clinical research has extensively focused on the efficacy of these drugs to reduce ischemic events. The bleeding risk associated with them was solely considered as an inevitable and acceptable complication. When two new potent P2Y12-receptor inhibitors, prasugrel and ticagrelor, were marketed, the risk of major bleeding increased. These new agents have modified the balance between the absolute risk reduction in ischemic events and the absolute risk increase in bleeding events. This paper is an update on the bleeding risk assessment associated with antiplatelet agents. It discusses the place of platelet function monitoring, and the optimal management of bleeding complications. It addresses the challenging issue of reversal of antiplatelet therapy, focusing especially on ticagrelor, which pharmacodynamics complicate bleeding management.
与所有抗血栓药物一样，抗血小板药物存在出血并发症风险。临床研究广泛聚焦于这些药物降低缺血性事件的疗效。与之相关的出血风险仅被视为一种不可避免且可接受的并发症。当两种新型强效P2Y12受体抑制剂普拉格雷和替格瑞洛上市后，大出血风险增加。这些新型药物改变了缺血性事件绝对风险降低与出血事件绝对风险增加之间的平衡。本文是关于抗血小板药物相关出血风险评估的最新进展。它讨论了血小板功能监测的作用以及出血并发症的最佳管理。它探讨了抗血小板治疗逆转这一具有挑战性的问题，尤其关注替格瑞洛，其药效学使出血管理变得复杂。
