急性冠脉综合征患者强化抗栓治疗研究进展  

Advances in Intensified Antithrombotic Therapies in Acute Coronary Syndrome

作　　者：邓天华 黄琳[1] 游志刚[1] DENG Tianhua;HUANG Lin;YOU Zhigang(Department of Cardiovascular Medicine,the Second Affiliated Hospital of Nanchang University,Nanchang 330006,China)

机构地区：[1]南昌大学第二附属医院心血管内科,江西省南昌市330006

出　　处：《中国全科医学》2023年第9期1131-1135,共5页Chinese General Practice

基　　金：江西省自然科学基金资助项目(20181BAB205083,20212BAB206042)。

摘　　要：急性冠脉综合征(ACS)是冠心病的严重类型,ACS患者不仅病死率较高,还存在缺血事件(如缺血性卒中、心肌梗死)复发风险。血小板聚集及血栓形成是导致ACS的重要原因。为降低缺血事件的发生风险,临床推荐ACS患者接受阿司匹林联合强效P2Y12抑制剂的双联抗血小板治疗12个月。然而在标准双联抗血小板治疗下,ACS患者残余缺血风险(经抗栓治疗后仍残留的缺血事件发生风险)仍旧较高。因此为进一步降低缺血事件发生风险,临床对强化抗栓方案的研究也逐渐增多。本文通过总结强化抗栓治疗方案的作用机制及其最新研究进展,发现延长双联抗血小板治疗时间、三联抗血小板治疗、双通道抑制(抗血小板联合抗凝治疗)等强化抗栓治疗方案可降低缺血事件发生风险,为进一步指导临床个体化抗栓治疗及明确最佳抗栓策略提供了参考。Acute coronary syndrome(ACS)is a serious coronary heart disease with relatively high mortality,and a history of ACS is associated with subsequent risk of recurrent ischemic events such as ischemic stroke and myocardial infarction.Platelet aggregation and thrombus formation are considered as indispensable factors that lead to ACS.To reduce the residual ischemic risk,it is clinically recommended that patients with ACS receive dual antiplatelet therapy with aspirin combined with a potent P2Y12 inhibitor for 12 months,but this therapy has been proven to be unsatisfactory in controlling the risk.More studies are ongoing to explore intensified antithrombotic therapies to reduce the risk of recurrent ischemic events.In this paper,the mechanisms of actions of and advances in intensified antithrombotic therapies in ACS were reviewed,and it is found that the risk of ischemic events can be further reduced by extended-term dual antiplatelet therapy,triple antiplatelet therapy and dual pathway inhibition therapy(namely antiplatelet therapy combined with anticoagulant therapy).This review will help to the implementation of clinical individualized antithrombotic therapy and the choice of the best antithrombotic strategy.

关 键 词：冠心病 急性冠脉综合征 抗血小板治疗 双通道抗栓 

分 类 号：R541.4[医药卫生—心血管疾病]