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脑梗死患者抗血小板药物的精准策略选择 |
马昱1, 吴旭青1, 毕晓莹2, 丁素菊2, 郝子龙3, 吴波3, 范薇1
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1.复旦大学附属中山医院神经内科, 上海 200032;2.海军军医大学长海医院神经内科, 上海 200433;3.四川大学华西医院神经内科, 成都 610041
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摘要: |
抗血小板治疗是脑梗死全程管理的重要手段之一,然而临床上存在抗血小板药物个体反应差异且其与患者预后密切相关,因此精准选择抗血小板药物具有重要意义。血小板功能检测及基因检测是抗血小板药物精准治疗的核心环节。对于存在高危缺血风险或预后较差、有高出血风险的患者,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常用的抗血小板药物,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,而携带CYP2C19失功能等位基因的患者,建议换用其他抗血小板药物。 |
关键词: 脑梗死 抗血小板药物 精准策略 基因检测 |
DOI:10.12025/j.issn.1008-6358.2022.20212696 |
分类号:R743 |
基金项目:国家重点研发计划项目(2017YFC0910003). |
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Accurate strategy of antiplatelet drugs in patients with cerebral infarction |
MA Yu1, WU Xu-qing1, BI Xiao-ying2, DING Su-ju2, HAO Zi-long3, WU Bo3, FAN Wei1
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1.Department of Neurology, Zhongshan Hospital, Fudan University, Shanghai 200032, China;2.Department of Neurology, Changhai Hospital, Naval Medical University, Shanghai 200433, China;3.Department of Neurology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, China
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Abstract: |
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. |
Key words: cerebral infarction antiplatelet drug accurate strategy genetic testing |