Mangels Daniel R, Nathan Ashwin, Tuteja Sony, Giri Jay, Kobayashi Taisei
Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA.
Curr Treat Options Cardiovasc Med. 2018 Feb 27;20(2):17. doi: 10.1007/s11936-018-0603-5.
Antiplatelet therapies are pivotal treatments in the management of acute coronary syndrome (ACS) with or without revascularization. In recent years, the use of P2Y12 antagonists prior to catheterization, so-called pretreatment, has been questioned, particularly in patients who may be at higher bleeding risks. The purpose of this review was to evaluate the current literature on contemporary and novel antiplatelet therapy in the pretreatment and treatment of ACS.
The P2Y12 receptor antagonists are associated with substantial reductions in morbidity and mortality for all types of ACS but only clopidogrel and ticagrelor have sufficient evidence for use in the pretreatment setting. The data regarding prasugrel support the use in patients undergoing percutaneous intervention (PCI). The glycoprotein IIa/IIIb antagonists are the most optimal for use in high-risk ACS as an adjuvant therapy during and after PCI. In summary, although all P2Y12 antagonists have morbidity- and mortality-reducing effects in ACS, only clopidogrel and ticagrelor have sufficient evidence in the pretreatment setting. Newer antiplatelet therapies, most notably the protease-activated receptor 1 antagonists, are evolving and promising but are associated with greater bleeding risks.
抗血小板治疗是急性冠脉综合征（ACS）无论是否进行血运重建治疗的关键。近年来，在导管插入术前使用P2Y12拮抗剂，即所谓的预处理，受到了质疑，尤其是在可能有较高出血风险的患者中。本综述的目的是评估当前关于ACS预处理和治疗中当代及新型抗血小板治疗的文献。
P2Y12受体拮抗剂可使各类ACS的发病率和死亡率大幅降低，但只有氯吡格雷和替格瑞洛有足够证据用于预处理。关于普拉格雷的数据支持其用于接受经皮冠状动脉介入治疗（PCI）的患者。糖蛋白IIa/IIIb拮抗剂是高危ACS在PCI期间及之后作为辅助治疗的最佳选择。总之，虽然所有P2Y12拮抗剂在ACS中都有降低发病率和死亡率的作用，但只有氯吡格雷和替格瑞洛在预处理方面有足够证据。更新的抗血小板治疗，最显著的是蛋白酶激活受体1拮抗剂，正在不断发展且前景光明，但与更高的出血风险相关。
