Platelet activation and inhibition in polycythemia vera and essential thrombocythemia
Platelet activation and inhibition in polycythemia vera and essential thrombocythemia
复制标题
DOI：
10.1182/blood-2012-10-429134
复制
发表时间：
2013-03-07
期刊：
影响因子：
20.3
通讯作者：
De Stefano, Valerio
中科院分区：
文献类型：
--
作者：
Patrono, Carlo;Rocca, Bianca;De Stefano, Valerio
持续增强的血小板活化以真性红细胞增多症 (PV) 和原发性血小板增多症 (ET) 为特征，并被证明会增加动脉和静脉血栓形成并发症的风险。 PV 和 ET 中主要出血并发症的发生率也略高于一般人群。尽管仅在一项相对较小的 PV 试验中评估了其有效性和安全性，但目前几乎所有 PV 和 ET 患者均推荐使用低剂量阿司匹林。尽管对于大多数有血栓形成史的患者来说，抗血小板治疗的获益/风险状况可能是有利的，但对于没有血栓形成史的患者，这种平衡将主要取决于个体患者的血栓形成和出血风险水平。最近关于低剂量阿司匹林化学预防作用的证据可能会倾斜利与弊的平衡，有利于更广泛地使用阿司匹林，但额外益处的潜力需要监管审查和新的治疗指南。明确的药效学原理和分析工具可用于 ET 抗血小板治疗的个性化方法，并且应在适当规模的随机试验中测试改进的低剂量阿司匹林治疗方案。
Persistently enhanced platelet activation has been characterized in polycythemia vera (PV) and essential thrombocythemia (ET) and shown to contribute to a higher risk of both arterial and venous thrombotic complications. The incidence of major bleeding complications is also somewhat higher in PV and ET than in the general population. Although its efficacy and safety was assessed in just 1 relatively small trial in PV, low-dose aspirin is currently recommended in practically all PV and ET patients. Although for most patients with a thrombosis history the benefit/risk profile of antiplatelet therapy is likely to be favorable, in those with no such history this balance will depend critically on the level of thrombotic and hemorrhagic risks of the individual patient. Recent evidence for a chemopreventive effect of low-dose aspirin may tilt the balance of benefits and harm in favor of using aspirin more broadly, but the potential for additional benefits needs regulatory scrutiny and novel treatment guidelines. A clear pharmacodynamic rationale and analytical tools are available for a personalized approach to antiplatelet therapy in ET, and an improved regimen of low-dose aspirin therapy should be tested in a properly sized randomized trial.