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抗血小板药物在急性冠状动脉综合征管理中的疗效、安全性及作用:文献综述

Efficacy, Safety, and Role of Antiplatelet Drugs in the Management of Acute Coronary Syndrome: A Comprehensive Review of Literature.

作者信息

Abubakar Muhammad, Raza Saud, Hassan Khawaja Mushammar, Javed Izzah, Hassan Khawaja Momal, Farrukh Fiza, Hassan Khawaja Muthammir, Faraz Muhammad Ahmad

机构信息

Department of Internal Medicine, Ameer-ud-Din Medical College, Lahore, PAK.

Department of Internal Medicine, Lahore Medical and Dental College, Lahore, PAK.

出版信息

Cureus. 2023 Mar 18;15(3):e36335. doi: 10.7759/cureus.36335. eCollection 2023 Mar.

Abstract

Acute coronary syndrome (ACS) is a complex condition characterized by myocardial ischemia or infarction which can lead to significant morbidity and death. Antiplatelet drugs play a crucial role in the management of ACS and have been shown to minimize the incidence of significant adverse cardiovascular events and recurrent myocardial infarction (MI). This comprehensive literature review is intended to summarize current information on the effectiveness, safety, and function of frequently used antiplatelet medications in treating ACS. Aspirin, clopidogrel, prasugrel, ticagrelor, abciximab, tirofiban, dipyridamole, cilostazol, and novel antiplatelets are included in the review. Aspirin's effectiveness as a first-line antiplatelet medication in ACS is well established. It has significantly lowered the risk of serious adverse cardiovascular events. Clopidogrel, prasugrel, and ticagrelor are P2Y12 receptor inhibitors found to lower the incidence of recurrent ischemia episodes in ACS patients. Using glycoprotein IIb/IIIa inhibitors such as abciximab, tirofiban, and eptifibatide is effective in managing ACS, especially in high-risk patients. Dipyridamole effectively reduces the risk of recurrent ischemic events in patients with ACS, particularly when used with aspirin. Cilostazol, a phosphodiesterase III inhibitor, has also been shown to reduce the risk of major adverse cardiovascular events (MACE) in patients with ACS. Antiplatelet drugs' safety in managing ACS has also been well established. Aspirin is generally well-tolerated with a low risk of adverse effects, although the risk of bleeding events, particularly gastrointestinal bleeding, cannot be eliminated. The P2Y12 receptor inhibitors have been associated with a small increase in the risk of bleeding events, particularly in patients with a high risk of bleeding. The glycoprotein IIb/IIIa inhibitors are associated with a higher risk of bleeding than other antiplatelet drugs, especially in high-risk patients. To summarize, antiplatelet drugs play a crucial role in the management of ACS, and the efficacy and safety of these drugs have been well-established in the literature. The choice of antiplatelet drugs will depend on the patient's risk factors, including age, comorbidities, and bleeding risk. The novel antiplatelets may offer new therapeutic options for managing ACS, and further studies are needed to determine their role in managing this complex condition.

摘要

急性冠状动脉综合征(ACS)是一种以心肌缺血或梗死为特征的复杂病症,可导致严重的发病和死亡。抗血小板药物在ACS的治疗中起着关键作用,已被证明可将严重不良心血管事件和复发性心肌梗死(MI)的发生率降至最低。这篇全面的文献综述旨在总结常用抗血小板药物在治疗ACS方面的有效性、安全性和作用。该综述包括阿司匹林、氯吡格雷、普拉格雷、替格瑞洛、阿昔单抗、替罗非班、双嘧达莫、西洛他唑和新型抗血小板药物。阿司匹林作为ACS一线抗血小板药物的有效性已得到充分证实。它显著降低了严重不良心血管事件的风险。氯吡格雷、普拉格雷和替格瑞洛是P2Y12受体抑制剂,被发现可降低ACS患者复发性缺血发作的发生率。使用糖蛋白IIb/IIIa抑制剂,如阿昔单抗、替罗非班和依替巴肽,对治疗ACS有效,尤其是在高危患者中。双嘧达莫可有效降低ACS患者复发性缺血事件的风险,特别是与阿司匹林合用时。西洛他唑是一种磷酸二酯酶III抑制剂,也已被证明可降低ACS患者发生主要不良心血管事件(MACE)的风险。抗血小板药物在治疗ACS方面的安全性也已得到充分证实。阿司匹林一般耐受性良好,不良反应风险较低,尽管出血事件的风险,特别是胃肠道出血的风险无法消除。P2Y12受体抑制剂与出血事件风险的小幅增加有关,特别是在出血风险高的患者中。糖蛋白IIb/IIIa抑制剂比其他抗血小板药物有更高的出血风险,特别是在高危患者中。总之,抗血小板药物在ACS的治疗中起着关键作用,这些药物的疗效和安全性在文献中已得到充分证实。抗血小板药物的选择将取决于患者的风险因素,包括年龄、合并症和出血风险。新型抗血小板药物可能为治疗ACS提供新的治疗选择,需要进一步研究以确定它们在治疗这种复杂病症中的作用。

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