脑梗死患者抗血小板药物的精准策略选择

抗血小板治疗是脑梗死全程管理的重要手段之一，然而临床上抗血小板药物存在个体反应差异且与预后密切相关，因此精准选择抗血小板药物具有重要意义。血小板功能检测及药物基因检测是抗血小板药物精准治疗的核心环节。对于高危缺血风险或预后较差、高出血风险的患者，可考虑行基因检测和（或）血小板功能检测。阿司匹林和氯吡格雷仍是目前最经典的抗血小板药物，其他抗血小板药物的有效性及安全性有待进一步验证。对于阿司匹林抵抗人群，不推荐增加阿司匹林剂量，可考虑换用其他抗血小板药物。基于CYP2C19基因型进行氯吡格雷剂量调整的策略仍有待研究，携带CYP2C19失功能等位基因的患者，建议换用其他抗血小板药物。

Accurate strategy of antiplatelet drugs in patients with cerebral infarction

Antiplatelet therapy is a major component of the management of cerebral infarction. However, there are differences in individual responses to antiplatelet drugs which are closely related to the clinical prognosis. Therefore, accurate selection of antiplatelet drugs is of great significance. Platelet function and genetic testing are core elements of precision treatment with antiplatelet drugs. For patients with high risk of ischemic event, poor prognosis or bleeding, genetic testing and/or platelet function testing may be considered. Aspirin and clopidogrel are currently classic antiplatelet drugs, and the effectiveness and safety of other antiplatelet drugs need to be further verified. For patients who are resistant to aspirin, it is recommended to consider switching to other antiplatelet drugs rather than to increase the dose of aspirin. The strategy of clopidogrel dose adjustment based on CYP2C19 genotype remains to be studied. Patients carrying CYP2C19 loss-of-function alleles are recommended to switch to other antiplatelet drugs.