The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Department of Internal Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA.
Expert Rev Cardiovasc Ther. 2023 May;21(5):311-328. doi: 10.1080/14779072.2023.2201437. Epub 2023 Apr 19.
Antiplatelet therapy is the cornerstone for prevention and management of ischemic complications among patients with coronary artery disease. Over the past decades, advancement in stent technologies and increasing awareness about the prognostic impact of major bleeding have led to evolving priorities in the management of antithrombotic regimens, from exclusive concerns regarding recurrent ischemic events to an individualized equipoise between ischemic and bleeding risk through a patient-centered comprehensive approach.
The purpose of this review is to highlight the current evidence that supports the various management strategies for antiplatelet therapy and discuss future directions of pharmacological regimens for coronary syndromes. We will also discuss the rationale behind use of antiplatelet therapy, current guideline recommendations, risk scores for ischemic and bleeding risk evaluation, and tools to help assess treatment response.
While tremendous advancements have been made in antithrombotic agents and regimens, future directions for antiplatelet therapy in patients with coronary artery disease would involve focus on novel therapeutic targets, development of new antiplatelet agents, implementation of more innovative regimens with current agents and further research to validate contemporary antiplatelet strategies.
抗血小板治疗是预防和治疗冠心病患者缺血性并发症的基石。在过去的几十年中，支架技术的进步和对主要出血预后影响的认识不断提高，导致抗栓治疗方案的管理重点也发生了变化，从单纯关注复发性缺血事件，转变为通过以患者为中心的综合方法，在缺血风险和出血风险之间取得个体化平衡。
本文旨在强调支持抗血小板治疗各种管理策略的现有证据，并讨论冠状动脉综合征药物治疗方案的未来方向。我们还将讨论抗血小板治疗的原理、当前指南建议、缺血和出血风险评估的风险评分，以及帮助评估治疗反应的工具。
虽然抗栓药物和方案取得了巨大进展，但未来冠心病患者的抗血小板治疗方向将涉及关注新的治疗靶点、开发新的抗血小板药物、实施更具创新性的现有药物方案，并进一步研究验证当代抗血小板策略。
