ADP受体阻滞剂的临床研究进展

Recent Advance in Clinical Research of ADP Receptor Blockade

阿斯匹林（Asp）通过单一的途径影响血小板的作用,几十年来一直是抗血小板治疗的主要药物,对心血管有不完全的保护作用,但阿斯匹林影响了血管紧张素转换酶抑制剂的血液动力学。双嘧达莫（潘生丁）有辅助的治疗作用,但没有迹象表明单用双嘧达莫或与阿斯匹林一起用比单独服用标准剂量的阿斯匹林更有效。口服血小板糖蛋白Ⅱb/Ⅲa受体阻滞剂,最初被认为很有希望,但在最近的临床试验中的结果却令人失望。新一代药物一噻吩并吡啶,通过阻滞5’-二磷酸腺苷（ADP）受体,抑制了血小板的活性。本文讨论了该类药物的药理作用、临床研究和应用价值,包括噻氯吡啶和氯吡格雷。5’-二磷酸腺苷受体阻滞剂通过另外的途径抑制了血小板的活性,在防治心血管疾病方面比阿斯匹林更有效。

Aspirin, Which has been the mainstay of antiplatelet agent for many decades, affects a single pathway in the platelet activation process and provides incomplete protection against cardiovascular events. Aspirin also may blunt the hemodynamic effect of angiotensin-converting enzyme inhibitors. Dipyridamole may provide some additional benefit, but there is little evidence to suggest its superiority alone or in combination with aspirin compared to standard doses of aspirin. Oral platelet glycoprotein IIb/IIIa inhibitors, although initially promising, have had disappointing results in recent clinical studies. Anew class of medications, the thienopyridines, blocks the activity of platelet adenosine 5i-diphosphate (ADP) receptors thereby reducing platelet activation. This review discusses the pharmacology, clinical studies, and potential uses of these agents, which include ticlopidine and clopidogrel. ADP inhibitors, by blocking an alternate pathway of platelet activation, are slightly more effective than aspirin in reducing cardiovascular events.