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首页> 外文期刊>Thrombosis and Haemostasis: Journal of the International Society on Thrombosis and Haemostasis >Insights into the role of thrombin in the pathogenesis of recurrent ischaemia after acute coronary syndrome
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Insights into the role of thrombin in the pathogenesis of recurrent ischaemia after acute coronary syndrome

机译：急性冠状动脉综合征后复发性缺血性发病机制中凝血酶在发病机制中的洞察

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Acute coronary syndrome (ACS) is a medical emergency. Patients who survive the initial event remain at risk of recurrent cardiovascular events. In most cases, ACS is triggered by thrombosis after rupture of an atherosclerotic plaque. Key to thrombus formation at this site is the generation of thrombin, which not only converts fibrinogen to fibrin but also serves as a potent platelet agonist and induces platelet aggregation at the site of vascular injury. Although dual antiplatelet therapy is more effective for the prevention of recurrent events than aspirin alone after ACS, there remains an approximately 10 % risk of recurrent ischaemic events at one year. Recent studies have evaluated whether the addition of an anticoagulant to antiplatelet therapy reduces the risk of recurrent ischaemia after an ACS event. Rivaroxaban, an oral factor Xa inhibitor, attenuates thrombin generation. When used in conjunction with dual antiplatelet therapy in patients with stabilised ACS, rivaroxaban 2.5 mg twice daily significantly reduced the risk of the composite endpoint of cardiovascular death, myocardial infarction and stroke compared with placebo. Although it increased the risk of bleeding, rivaroxaban was associated with a reduction in mortality; a finding that supports the use of a dual-pathway approach that combines anticoagulant and antiplatelet therapy. This review explores the pathophysiology of ACS to provide perspective on the results of recent clinical trials with novel oral anticoagulants for ACS and to identify their potential role in this setting.
机译：急性冠状动脉综合征（ACS）是医疗紧急情况。在初始事件中存活的患者仍存在复发性心血管事件的风险。在大多数情况下，ACS在动脉粥样硬化斑块破裂后被血栓形成触发。该遗址血栓形成的关键是凝血酶的产生，这不仅将纤维蛋白原转化为纤维蛋白，而且还用作效力的血小板激动剂，并在血管损伤部位诱导血小板聚集。虽然双抗血小板治疗对于在ACS中单独预防来自阿司匹林的反复事件更有效，但一年内仍有大约10％的经常性缺血事件的风险。最近的研究评估了对抗血小板治疗的抗凝血剂是否会降低ACS事件后复发性患者的风险。 Rivaroxaban是一种口腔因子Xa抑制剂，衰减凝血酶产生。当与稳定的ACS患者的双抗血小板治疗结合使用时，Rivaroxaban与安慰剂相比，Rivaroxaban 2.5毫克每天两次显着降低心血管死亡，心肌梗死和中风的复合终点的风险。虽然它增加了出血的风险，但Rivaroxaban与降低死亡率有关;一种支持使用与抗凝血剂和抗血小板治疗的双途径方法使用的发现。本综述探讨了AC的病理生理学，提供了对近期临床试验的结果，该临床试验与ACS的新口腔抗凝血剂和识别其在该环境中的潜在作用。

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