吲哚布芬(美国胸科协会抗血小板药物指南)

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2024年7月11日发(作者：)

Antiplatelet Drugs

*

Carlo Patrono, Colin Baigent, Jack Hirsh and Gerald Roth

Chest 2008;133;199S-233S

DOI 10.1378/chest.08-0672

The online version of this article, along with updated information

and services can be found online on the World Wide Web at:

/content/133/6_suppl/199S.f

CHEST is the official journal of the American College of Chest

Physicians. It has been published monthly since 1935. Copyright 2008

by the American College of Chest Physicians, 3300 Dundee Road,

Northbrook, IL 60062. All rights reserved. No part of this article or PDF

may be reproduced or distributed without the prior written permission

of the copyright holder.

(/site/misc/)

ISSN:0012-3692

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© 2008 American College of Chest Physicians

Supplement

ANTITHROMBOTICANDTHROMBOLYTICTHERAPY8THED:ACCPGUIDELINES

AntiplateletDrugs*

AmericanCollegeofChestPhysicians

Evidence-BasedClinicalPracticeGuidelines

(8thEdition)

CarloPatrono,MD;ColinBaigent,MD;JackHirsh,MD,FCCP;

andGeraldRoth,MD

ThisarticleaboutcurrentlyavailableantiplateletdrugsispartoftheAntithromboticandThrombo-

lyticTherapy:AmericanCollegeofChestPhysiciansEvidence-BasedClinicalPracticeGuidelines

(8thEdition).Itdescribesthemechanismofaction,pharmacokinetics,andpharmacodynamicsof

aspirin,reversiblecyclooxygenaseinhibitors,thienopyridines,andintegrin␣IIb␤3receptorantago-

ationshipsamongdose,efficacy,andsafetyarethoroughlydiscussed,withamechanistic

icledoesnotprovidespecificmanagementrecommen-

dations;however,itdoeshighlightimportantpracticalaspectsrelatedtoantiplatelettherapy,

includingtheoptimaldoseofaspirin,thevariablebalanceofbenefitsandhazardsindifferentclinical

settings,andtheissueofinterindividualvariabilityinresponsetoantiplateletdrugs.

(CHEST2008;133:199S–233S)

Keywords:abciximab;antiplateletdrugs;aspirin;clopidogrel;dipyridamole;eptifibatide;plateletpharmacology;resistance;

ticlopidine;tirofiban

Abbreviations:ACEϭangiotensin-convertingenzyme;ADPϭadenosinediphosphate;AMPϭadenosinemonophos-

phate;ATTϭAntithromboticTrialists;CAPRIEϭClopidogrelvsAspirininPatientsatRiskofIschemicEvents;

CHDϭcoronaryheartdisease;CIϭconfidenceinterval;COMMITϭClopidogrelandMetoprololMyocardialInfarction

Trial;COXϭcyclooxygenase;CUREϭClopidogrelinUnstableAnginatoPreventRecurrentEvents;EPICϭEvaluationof

7E3forthePreventionofIschemicComplications;ESPSϭEuropeanStrokePreventionStudy;ESPRITϭEuropeanStroke

PreventionReversibleIschemiaTrial;FDAϭFoodandDrugAdministration;GPϭglycoprotein;INRϭinternational

normalizedratio;MIϭmyocardialinfarction;NSAIDϭnonsteroidalantiinflammatorydrug;ORϭoddsratio;

PCIϭpercutaneouscoronaryintervention;PEϭpulmonaryembolism;PGϭprostaglandin;PTCAϭpercutaneoustrans-

luminalcoronaryangioplasty;RRϭrateratio;TIAϭtransientischemicattack;TXϭthromboxane;TTPϭthrombotic

thrombocytopenicpurpura

P

lateletsarevitalcomponentsofnormalhemosta-

sisandkeyparticipantsinatherothrombosisby

virtueoftheircapacitytoadheretoinjuredblood

vesselsandtoaccumulateatsitesofinjury.

1

Al-

*FromtheCatholicUniversitySchoolofMedicine(o),

Rome,Italy;ClinicalTrialServiceUnit(t),University

ofOxford,Oxford,UK;HamiltonCivicHospitals(),

HendersonResearchCentre,Hamilton,ON,Canada;andSeattle

VAMedicalCenter(),Seattle,WA.

owassupportedinpartbyagrantfromtheEuropean

CommissionFP6(LSHM-CT-2004-005033).

ManauscriptacceptedDecember20,2007.

Reproductionofthisarticleisprohibitedwithoutwrittenpermission

fromtheAmericanCollegeofChestPhysicians(ournal.

org/misc/).

Correspondenceto:CarloPatrono,MD,CatholicUniversity

SchoolofMedicine,1,00168Rome,Italy;e-mail:

o@

DOI:10.1378/chest.08-0672

thoughplateletadhesionandactivationcanbe

viewedasaphysiologicrepairresponsetothesud-

denfissuringorruptureofanatheroscleroticplaque,

uncontrolledprogressionofsuchaprocessthrougha

seriesofself-sustainingamplificationloopscanlead

tointraluminalthrombusformation,vascularocclu-

sion,tly

availableantiplateletdrugsinterferewithsomesteps

intheactivationprocess,includingadhesion,release,

and/oraggregation,

1

andhaveameasurableimpact

ontheriskofarterialthrombosisthatcannotbe

dissociatedfromanincreasedriskofbleeding.

2

Indiscussingantiplateletdrugs,itisimportantto

appreciatethatapproximately10

11

plateletsarepro-

ducedeachdayunderphysiologiccircumstances,a

levelofproductionthatcanincreaseupto10-foldat

CHEST/133/6/JUNE,2008SUPPLEMENT

199S

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