Clinical considerations with the use of antiplatelet therapy in patients undergoing percutaneous coronary intervention
Clinical considerations with the use of antiplatelet therapy in patients undergoing percutaneous coronary intervention
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DOI：
10.1002/clc.20359
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发表时间：
2008-03-01
影响因子：
2.7
通讯作者：
Wiviott, Stephen
中科院分区：
文献类型：
--
作者：
Braunwald, Eugene;Angiolillo, Dominick;Wiviott, Stephen
尽管在接受经皮冠状动脉介入治疗（PCI）的患者中使用抗血小板治疗已被证明是有益的，但仍有许多关键问题有待回答。近年来，此类患者的氯吡格雷给药策略已发生了相当大的变化，新方法涉及PCI前的负荷剂量，并增加时间间隔和负荷剂量，以克服对血小板抑制的可变反应性/低反应性。此外，糖蛋白（GP）IIb/IIIa拮抗剂在择期支架植入术中的作用仍在确定中，最近的证据表明这些药物最适合用于肌钙蛋白水平升高的高危患者。GP IIb/IIIa拮抗剂与氯吡格雷负荷的使用与早期炎症和心脏标志物释放的衰减之间似乎存在关系。在接受药物洗脱支架（DES）的患者中，降低晚期支架血栓形成机会的策略也在紧张的研究中。在一些接受西罗莫司和紫杉醇DES的患者中，目前标准的长期抗血小板策略可能不足。患者不依从治疗和过早停药以及医生未充分利用抗血小板治疗仍然是重要的临床问题，具有潜在的可怕后果。
Despite the proven benefits of using antiplatetet therapy in patients undergoing percutaneous coronary intervention (PCI), a number of key questions remain to be answered. In recent years, clopidogrel dosing strategies among such patients have evolved considerably, with newer approaches involving loading doses prior to PCI and increases in the time interval and loading dosage in an effort to overcome variable responsiveness/hyporesponsiveness to platelet inhibition. Further, the rote of glycoprotein (GP) IIb/IIIa antagonists in elective stenting continues to be defined, with recent evidence suggesting that most appropriate use of these agents is in high-risk patients with elevated troponin levels. There appears to be a relationship between the use of GP IIb/IIIa antagonists with clopidogrel loading and attenuation of early inflammatory and cardiac marker release. Strategies to minimize the chance of late stent thrombosis in patients who receive drug-eluting stents (DES) are also under intense investigation. Among some patients receiving sirolimus and paclitaxel DES, current standard long-term antiplatelet strategies may be insufficient. Patient nonadherence to treatment and premature discontinuation and underutilization of antiplatelet therapies by physicians remain important clinical problems with potentially dire consequences.