Center for Platelet Research Studies, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, and.
Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA.
Blood. 2017 Aug 10;130(6):713-721. doi: 10.1182/blood-2017-03-742338. Epub 2017 Jun 9.
Antiplatelet therapy is of proven benefit in coronary artery disease and a number of other clinical settings. This article reviews platelet function, molecular targets of antiplatelet agents, and clinical indications for antiplatelet therapy before focusing on a frequent question to hematologists about the 2 most commonly used antiplatelet therapies: Could the patient be aspirin "resistant" or clopidogrel "resistant"? If so, should results of a platelet function test be used to guide the dose or type of antiplatelet therapy? Whether such guided therapy is of clinical benefit to patients has been a source of controversy. The present article reviews this subject in the context of 2 prototypical clinical cases. Available evidence does not support the use of laboratory tests to guide the dose of aspirin or clopidogrel in patients with so-called aspirin or clopidogrel "resistance."
抗血小板治疗已被证实对冠心病和许多其他临床情况有益。本文首先回顾了血小板功能、抗血小板药物的分子靶点以及抗血小板治疗的临床适应证，然后重点探讨了血液科医生经常遇到的一个问题，即两种最常用的抗血小板治疗方法：患者是否存在阿司匹林“抵抗”或氯吡格雷“抵抗”？如果存在，血小板功能检测结果是否可用于指导抗血小板治疗的剂量或类型？这种有针对性的治疗方法是否对患者具有临床益处一直存在争议。本文在 2 个典型临床病例的背景下对此进行了综述。目前的证据不支持使用实验室检测来指导所谓的阿司匹林或氯吡格雷“抵抗”患者的阿司匹林或氯吡格雷剂量。
