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抗血小板药物在镰状细胞病患者管理中的作用

The Role of Antiplatelet in the Management of Sickle Cell Disease Patients.

作者信息

Naramreddy Sudheeshreddy, Varma Ashish, Taksande Amar, Meshram Revat J

机构信息

Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND.

出版信息

Cureus. 2023 Jul 18;15(7):e42058. doi: 10.7759/cureus.42058. eCollection 2023 Jul.

Abstract

Sickle cell disease (SCD) is a genetic disorder characterized by abnormal hemoglobin, leading to red blood cell deformities and subsequent vaso-occlusive events. Platelet activation and adhesion play a significant role in the pathophysiology of SCD, contributing to the development of complications such as vaso-occlusive events, stroke, acute chest syndrome, and other manifestations. Antiplatelet therapy has emerged as a potential strategy to mitigate these complications by modulating the platelet function and reducing thrombotic events. This review article provides an overview of antiplatelet therapy's role in managing SCD patients. It discusses the pathophysiological abnormalities in the platelet function in SCD, the rationale for antiplatelet therapy, and the evidence supporting its use in various clinical scenarios. The article explores aspirin as the primary antiplatelet agent in SCD, including its mechanism of action, dosing considerations, and efficacy and safety data. Additionally, it highlights other antiplatelet agents, such as clopidogrel, prasugrel, ticagrelor, and emerging therapies under investigation. Clinical applications of antiplatelet therapy in primary and secondary prevention and the management of acute chest syndrome and other SCD complications are also discussed. Safety considerations are emphasized, including bleeding risk assessment, monitoring, and patient selection for antiplatelet therapy. Finally, the review highlights future research and clinical practice directions, including the development of novel antiplatelet agents, combination therapies, and the integration of antiplatelet therapy with other SCD treatments. Overall, this review provides a comprehensive understanding of the current role of antiplatelet therapy in SCD management, the challenges faced, and future directions for improving patient outcomes.

摘要

镰状细胞病(SCD)是一种遗传性疾病,其特征为血红蛋白异常,导致红细胞畸形以及随后的血管阻塞事件。血小板活化和黏附在SCD的病理生理学中起重要作用,促使诸如血管阻塞事件、中风、急性胸综合征及其他表现等并发症的发生。抗血小板治疗已成为一种潜在策略,可通过调节血小板功能和减少血栓形成事件来减轻这些并发症。这篇综述文章概述了抗血小板治疗在管理SCD患者中的作用。它讨论了SCD中血小板功能的病理生理异常、抗血小板治疗的原理以及支持其在各种临床情况下使用的证据。文章探讨了阿司匹林作为SCD中的主要抗血小板药物,包括其作用机制、剂量考量以及疗效和安全性数据。此外,它还强调了其他抗血小板药物,如氯吡格雷、普拉格雷、替格瑞洛以及正在研究的新兴疗法。还讨论了抗血小板治疗在一级和二级预防以及急性胸综合征和其他SCD并发症管理中的临床应用。强调了安全性考量,包括出血风险评估、监测以及抗血小板治疗的患者选择。最后,该综述突出了未来的研究和临床实践方向,包括新型抗血小板药物的开发、联合治疗以及抗血小板治疗与其他SCD治疗方法的整合。总体而言,这篇综述全面阐述了抗血小板治疗在SCD管理中的当前作用、面临的挑战以及改善患者预后的未来方向。

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