抗血小板治疗实验室监测之我见

抗血小板药物在各种动脉血栓性疾病防治中具有重要地位。虽然目前抗血小板药物多采用固定剂量给药，但不同患者对抗血小板治疗的反应性存在明显差异。治疗后的血小板高反应性或低反应性可能与血栓事件或出血事件风险相关。基于血小板功能检测的个体化抗血小板治疗方案可能有助于预防血栓或出血不良事件的发生，但目前仍缺乏上述治疗策略能够最终改善患者预后的确切临床证据。迄今为止，对于接受抗血小板治疗的患者是否应常规进行实验室监测仍存在诸多争议。本文对抗血小板治疗反应多样性的成因及血小板功能检测是否可用于指导个体化抗血小板治疗进行讨论。

Antiplatelet Therapy: the Role of Platelet Function Monitoring

Antiplatelet therapy is of proven benefit to arterial thrombotic diseases. Although antiplatelet agents are usually given on fixed dosages, there is great interindividual variability in pharmacodynamic response to antiplatelet medications. Patients with high on-treatment platelet reactivity are at increased risk for thrombotic events. On the contrary, low on-treatment platelet reactivity has been linked to a higher risk of bleeding. Personalized antiplatelet treatment strategies based on platelet function monitoring constitute a promising tool for the prevention of both thrombotic and bleeding events, but the conclusive evidence for improved clinical outcomes with such approaches is yet lacking. Up to now, whether routine laboratory monitoring of antiplatelet therapy is of clinical benefit is still controversial. This review discusses the causes of variability in the response to aspirin or clopidogrel and highlights the current position of platelet function testing in guiding personalized antiplatelet therapy.