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首页> 外文期刊>Heartdrug: excellence in cardiovascular trials >Clopidogrel - Confounding or confirming our concept of how to treat acute coronary syndromes?
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Clopidogrel - Confounding or confirming our concept of how to treat acute coronary syndromes?

机译：氯吡格雷 - 混淆或确认我们如何治疗急性冠状动脉综合症的概念？

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Clopidogrel, a thienopyridine derivative, selectively and irreversibly inhibits the platelet ADP receptor resulting in platelet inhibition. The utilisation of clopidogrel in the setting of coronary artery disease has been studied in three multicentre trials: CAPRIE, CLASSICS and the CURE study. These clinical trials generally suggest that patients with atherosclerotic vascular disease are more effectively managed with long-term clopidogrel than aspirin in reducing the combined risk of ischaemic stroke, myocardial infarction or vascular death, that the combination of clopidogrel and aspirin is safer when compared to ticlopidine and aspirin following percutaneous coronary intervention and that the use of clopidogrel and aspirin is beneficial in patients with acute coronary syndromes without ST segment elevation by reducing major cardiac events when compared with placebo and aspirin. Patients in the CURE study were managed initially 'conservatively' with aspirin and clopidogrel. However, recent studies have shown that managing these high-risk patients by pretreatment with antiplatelet and antithrombin agents (aspirin, heparin, clopidogrel and a glycoprotein IIb/IIIa inhibitor) followed by early revascularisation is beneficial. The combination of clopidogrel with aspirin, heparin and a glycoprotein IIb/IIIa inhibitor appears safe, though this requires further study. Furthermore, the risk of bleeding in patients requiring coronary artery bypass graft surgery within 5 days of initiation of clopidogrel is of concern. The length of treatment required with clopidogrel to provide optimum benefit is still not clear. Copyright 2002 S. Karger AG, Basel.
机译：氯吡格雷是一种硫烯吡啶衍生物，有选择地和不可逆地抑制血小板ADP受体，导致血小板抑制作用。在三项多中心试验中，已经研究了氯吡格雷在冠状动脉疾病中的利用：CAPRIE，经典和治疗研究。这些临床试验通常表明，与阿司匹林相比，与阿司匹林相比，患有动脉粥样硬化血管疾病的患者更有效地控制着长期的氯吡格雷，在降低缺血性中风，心肌梗塞或血管死亡的综合风险中，与氯吡啶和阿司匹林的结合相比，与ticlopidine相比，相结合和经皮冠状动脉干预后的阿司匹林以及使用氯吡格雷和阿司匹林的使用对无急性冠状动脉综合征的患者有益于没有ST片段升高的患者，而与安慰剂和阿司匹林相比，通过减少重大心脏事件。治疗研究中的患者最初用阿司匹林和氯吡格雷“保守”。然而，最近的研究表明，通过用抗血小板和抗凝血酶（阿司匹林，肝素，氯吡格雷和糖蛋白IIB/IIIA抑制剂）进行预处理治疗这些高风险患者，然后进行早期血运重建。氯吡格雷与阿司匹林，肝素和糖蛋白IIB/IIIA抑制剂的组合似乎是安全的，尽管这需要进一步研究。此外，需要在氯吡格雷开始后5天内需要冠状动脉搭桥手术的患者出血的风险。氯吡格雷为提供最佳益处所需的治疗时间尚不清楚。版权 2002 S. Karger AG，巴塞尔。

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