Platelet function testing in contemporary clinical and interventional practice.
Platelet function testing in contemporary clinical and interventional practice.
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DOI：
10.1007/s11936-014-0300-y
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发表时间：
2014-05-01
影响因子：
--
通讯作者：
Angiolillo, Dominick J
中科院分区：
文献类型：
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作者：
Franchi, Francesco;Rollini, Fabiana;Angiolillo, Dominick J
意见声明：联合阿司匹林和ADP P2Y12受体抑制剂的双重抗血小板治疗是急性冠状动脉综合征或正在接受经皮冠状动脉介入治疗（PCI）的患者的推荐治疗。然而，患者可能会继续出现缺血性复发，包括支架内血栓形成，这与抗血小板治疗（尤其是氯吡格雷）的个体反应的众所周知的变异性有关。目前有几种测定方法可用于测量血小板反应性，血小板功能检测已被证明是评估抗血小板药物药效学疗效的有价值的工具。此外，血小板反应性具有重要的预后意义，因为几项研究已分别显示高和低血小板反应性患者的血栓形成和出血事件相关。因此，在过去的几年里，有大量的研究调查了与最高的缺血性并发症保护和最低的出血风险相关的血小板反应性的最佳范围。考虑到治疗中血小板反应性和结局之间的相关性，也提倡使用血小板功能检测来创建个性化的抗血小板治疗。在这一领域已经进行了几项研究，但主要的临床试验未能证明这种策略在改善临床结局方面的益处。事实上，这些试验的内在局限性可能是导致其失败的原因之一。本文概述了血小板功能检测在当代临床和介入实践中的作用。
OPINION STATEMENT: Dual antiplatelet therapy with a combination of aspirin and an inhibitor of the ADP P2Y12 receptor is the recommended treatment for patients with acute coronary syndrome or who are undergoing percutaneous coronary intervention (PCI). However, patients may continue to have ischemic recurrences, including stent thrombosis, which have been linked with the well-known variability in individual response to antiplatelet therapy, and clopidogrel in particular. There are currently several assays available to measure platelet reactivity, and platelet function testing has been shown to be a valuable tool to assess the pharmacodynamic efficacy of antiplatelet drugs. Moreover, platelet reactivity has important prognostic implications, as several studies have shown an association with thrombotic and bleeding events in patients with high and low platelet reactivity, respectively. Consequently, over the past years there has been a plethora of studies investigating the optimal range of platelet reactivity associated with the highest protection against ischemic complications and the lowest risk of bleeding. Given the correlation between on-treatment platelet reactivity and outcomes, the use of platelet function testing has also been advocated to create personalized antiplatelet therapy. Several studies have been conducted in this field, but major clinical trials have failed to demonstrate a benefit of such a strategy in improving clinical outcomes. Indeed, inherent limitations of these trials may have contributed to their failure. The present manuscript provides an overview on the role of platelet function testing in contemporary clinical and interventional practice.