冠心病患者氯吡格雷抵抗研究(2)
3.4.3其他因素:引起氯吡格雷抵抗的其他因素包括ADP释放增加,血小板对胶原纤维、血栓素、肾上腺素等反应性增强,血小板产生增多及更新加快等。此外,治疗前高血小板活性和高血栓负荷、超重及胰岛素抵抗或糖尿病,对氯吡格雷抵抗均有促进作用。
3.5尽管相当一部分患者存在氯吡格雷抵抗,但这并不能动摇氯吡格雷在临床防治缺血性事件的地位。氯吡格雷抵抗的存在与临床不良事件的相关程度尚需大量研究证实,所以我们在临床应用的同时,要充分利用目前的检测条件,尽可能的发现低反应或无反应患者,给与综合干预,减少临床事件的发生。
参考文献
[1]Gurbel PA,Samara WM,Bliden KP.Failure of clopidogrel to reduce platelet reactivity and activation following standard dosing in elective stenting:implications for thrombotic events and restenosis.Platelets,2004,15(2):95-9.
[2]Gurbel PA,Bliden KP,Hiatt BL,et al.Clopidogrel for coronary stenting:response variability,drug resistance,and the effect of pretreatment platelet reactivity.Circulation,2003,17,107(23):2908-13.
[3]Matetzky S,Shenkman B,Guetta V,et al.Clopidogrel resistance is associated with increased risk of recurrent atherothrombotic events in patients with acute myocardial infarction.Circulation,2004,29,109(25):3171-5.
[4]Lau WC,Waskell LA,Watkins PB,et al.Atorvastatin reduces the ability of clopidogrel to inhibit platelet aggregation:a new drug-drug interaction.Circulation,2003,107(1):32-37.
[5]Fontana P,Dupont A,Gandride,et al.Adenosine diphosphate-induced platelet aggregation is associated with P2Y12 gene sequence variations in healthy subjects[J].Circulation,2003,108(8):989-995.
[6]Nguyen TA,Diodati JG,Pharand C.Resistance to clopidogrel:a review of the evidence[J].J Am Coll Cardiol,2005,45(8):1157-1164.
[7]Hulot JS,Bura A,Villard E,et al.Cytochrome P4502C19 loss-of-function polymorphism is a major determinant of clopidogrel responsiveness in healthy subjects[J].Blood,2006,108(7):2244-224., http://www.100md.com
3.5尽管相当一部分患者存在氯吡格雷抵抗,但这并不能动摇氯吡格雷在临床防治缺血性事件的地位。氯吡格雷抵抗的存在与临床不良事件的相关程度尚需大量研究证实,所以我们在临床应用的同时,要充分利用目前的检测条件,尽可能的发现低反应或无反应患者,给与综合干预,减少临床事件的发生。
参考文献
[1]Gurbel PA,Samara WM,Bliden KP.Failure of clopidogrel to reduce platelet reactivity and activation following standard dosing in elective stenting:implications for thrombotic events and restenosis.Platelets,2004,15(2):95-9.
[2]Gurbel PA,Bliden KP,Hiatt BL,et al.Clopidogrel for coronary stenting:response variability,drug resistance,and the effect of pretreatment platelet reactivity.Circulation,2003,17,107(23):2908-13.
[3]Matetzky S,Shenkman B,Guetta V,et al.Clopidogrel resistance is associated with increased risk of recurrent atherothrombotic events in patients with acute myocardial infarction.Circulation,2004,29,109(25):3171-5.
[4]Lau WC,Waskell LA,Watkins PB,et al.Atorvastatin reduces the ability of clopidogrel to inhibit platelet aggregation:a new drug-drug interaction.Circulation,2003,107(1):32-37.
[5]Fontana P,Dupont A,Gandride,et al.Adenosine diphosphate-induced platelet aggregation is associated with P2Y12 gene sequence variations in healthy subjects[J].Circulation,2003,108(8):989-995.
[6]Nguyen TA,Diodati JG,Pharand C.Resistance to clopidogrel:a review of the evidence[J].J Am Coll Cardiol,2005,45(8):1157-1164.
[7]Hulot JS,Bura A,Villard E,et al.Cytochrome P4502C19 loss-of-function polymorphism is a major determinant of clopidogrel responsiveness in healthy subjects[J].Blood,2006,108(7):2244-224., http://www.100md.com