冠状动脉疾病抗血小板治疗新策略

A. Schäfer, J. Bauersachs, M. Eigenthaler
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引用次数: 6

摘要

口服抗血小板药物治疗是冠状动脉疾病治疗的基石。冠状动脉成形术和支架植入术改善了冠状动脉疾病的治疗,特别是对急性心肌梗死的治疗。糖蛋白IIb/IIIa抑制的实施进一步推进了抗血小板治疗作为急性冠状动脉综合征治疗的核心组成部分。当引入双重抗血小板治疗并将稳定冠状动脉疾病患者择期支架植入术后支架血栓形成风险降低至1%时,可实现持续预防再闭塞。然而,针对更复杂的病变或在血小板反应性增加的状态下进行干预,如急性冠状动脉综合征或糖尿病患者,仍然与支架血栓形成的高风险相关。此外,噻吩吡啶治疗对ADP受体的不完全抑制有助于增加冠状动脉介入治疗后的心血管事件和死亡率。本文综述了导致冠状动脉粥样硬化血栓形成和支架血栓形成的潜在病理生理,以及通过双重抗血小板治疗预防血栓形成的药理学方法。综述了血小板聚集、血小板功能分析仪、血小板反应性指数等不同分析方法对抗血小板治疗效果的评价。本文讨论了氯吡格雷反应性受损及其对不良心血管事件和支架血栓形成的影响。目前提高氯吡格雷治疗效果的策略以及下一代抗血小板物质,如新型噻吩吡啶类和非噻吩吡啶类p2y12受体阻滞剂。最后,我们讨论了与糖蛋白IIb/IIIa抑制剂相比,范氏血血病因子适体在急性冠状动脉综合征中的潜力。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Novel Strategies in Anti-Platelet Treatment for Coronary Artery Disease
Treatment with oral anti-platelet agents constitutes a cornerstone in the therapy of coronary artery disease. Coronary angioplasty and stent implantation improved the therapy of coronary artery disease and especially the treatment of acute myocardial infarction. Implementation of glycoprotein IIb/IIIa inhibition further advanced anti-platelet therapy as a central component in the treatment of acute coronary syndromes. Sustained prevention of reocclusion was achieved when dual anti-platelet therapy had been introduced and reduced the risk of stent thrombosis to ~1% following elective stenting in stable coronary artery disease. However, targeting more complex lesions or performing the intervention in states of increased platelet reactivity such as in acute coronary syn- dromes or in diabetic patients is still associated with a higher risk of stent thrombosis. Additionally, incomplete ADP- receptor inhibition by thienopyridine treatment contributes to increased cardiovascular events and mortality after coronary intervention. This review describes the underlying pathophysiology leading to coronary atherothrombosis and contributing to stent thrombosis as well as the pharmacological approach to prevent it by dual anti-platelet therapy. It summarizes the assess- ment of anti-platelet therapy by different analytical methods such as platelet aggregation, platelet function analyzers, and the platelet reactivity index. Impaired clopidogrel responsiveness and its implication for adverse cardiovascular events and stent thrombosis are discussed. Current strategies in improving the efficacy of clopidogrel treatment as well as the next generation of anti-platelet substances such as novel thienopyridines and non-thienopyridine P2Y12-receptor blocking agents are addressed. Finally, we discuss the potential of von-Willebrand factor aptamers compared to glycoprotein IIb/IIIa inhibitors in acute coronary syndromes.
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