Deharo Pierre, Cuisset Thomas
Département de Cardiologie, CHU Timone, Marseille, France.
UMR MD2, Aix-Marseille Université, Marseille, France.
Cardiovasc Diagn Ther. 2018 Oct;8(5):621-629. doi: 10.21037/cdt.2018.10.10.
Dual antiplatelet therapy, with aspirin plus a P2Y12 inhibitor agent, remains the cornerstone treatment after percutaneous coronary intervention. However, significant proportion of patients did experience recurrent ischemic events on aspirin plus clopidogrel and the concept of non-response to P2Y12 inhibitor emerged. Evaluation of platelet reactivity has known a promising era aiming to improve platelet inhibition conferred by clopidogrel. Then, the development of more potent antiplatelet agents (i.e., prasugrel and ticagrelor) shifted the concern to excessive platelet inhibition and increased risk of bleeding. Therefore, personalized antiplatelet therapy according to platelet function testing has been tested in several randomized trials for both escalation and de-escalation of antiplatelet regimen. This review aims to report the evidence from randomized trials in this field and upcoming roles for platelet function testing.
双联抗血小板治疗，即阿司匹林联合一种P2Y12抑制剂，仍然是经皮冠状动脉介入治疗后的基石疗法。然而，相当一部分患者在服用阿司匹林加氯吡格雷后确实经历了复发性缺血事件，对P2Y12抑制剂无反应的概念由此出现。血小板反应性评估迎来了一个充满希望的时代，旨在提高氯吡格雷赋予的血小板抑制作用。随后，更有效的抗血小板药物（即普拉格雷和替格瑞洛）的出现，将关注点转移到了血小板过度抑制和出血风险增加上。因此，根据血小板功能检测进行个性化抗血小板治疗已在多项随机试验中进行了测试，用于抗血小板治疗方案的强化和弱化。本综述旨在报告该领域随机试验中的证据以及血小板功能检测未来的作用。
