王贵松博士：《新型抗血小板药物在临床中的应用》
发布于:2009-07-24 10:27
引言：第12届全国介入心脏病学论坛暨北京大学心血管论坛即将拉开帷幕，我们非常荣幸地邀请到北京大学第三医院、介入论坛执行秘书长王贵松教授做客医心网，为我们介绍抗血小板治疗的最新循证医学证据。
来源： 医心网
医心：王教授，您好。循证医学是公认的对临床医学研究最有力的证据来源，同时也是本届介入论坛的亮点之一，您作为第12届全国介入心脏病学论坛暨北京大学心血管论坛执行秘书长之一，请您谈谈此次论坛在哪些方面体现了“循证”二字。
王教授：全国介入心脏病学论坛秉承“规范、提高”的宗旨在不断发展和壮大，本届论坛特设了两个与“循证”相关的版块：一是循证医学论坛。在这个论坛上将由国内权威的循证医学和流行病学专家，以及临床经验丰富的心血管病专家共同探讨循证医学的话题。二是2008年重要临床试验盘点。选取2008年国际上有较大影响的临床试验和研究，如TRITON试验、JUPITER试验、SYNTAX研究、FAME研究等。由国内知名专家进行解读和点评，使大家真正理解临床试验对临床实践指导意义和参考价值。
医心：感谢王教授对此问题的精彩阐述，抗凝抗栓一直是大家比较关注的话题，也是一个老话题，请您谈谈抗血小板药物治疗的最新循证医学证据。
王教授：抗血小板药物大家都很熟悉，也很关心。近两年来，有关口服抗血小板药物的循证依据较为突出。尤其随着对药物洗脱支架晚期血栓形成问题的忧虑，抗血小板治疗问题备受关注。从循证角度来说，从最经典的环氧化酶抑制剂阿司匹林到二磷酸腺苷ADP受体拮抗剂噻吩吡啶类抗血小板药的临床应用，无论从用药剂量、时机还是疗程，基本上都是遵循临床试验研究的结果。2007年底以来，国际上比较有影响力的一个临床试验，本次论坛也将对此研究进行讨论——TRITON-TIMI 38研究。研究设计对拟行介入治疗的ACS患者，应用新型的ADP受体拮抗剂prasugrel（普拉格雷）与氯吡格雷进行有效性和安全性比较。12个月随访结果显示，普拉格雷+阿司匹林组缺血性心脏事件比氯吡格雷+阿司匹林组降低了19%，支架内血栓发生率降低了约50%，但是出血事件率增加了32%。TRITON研究结果为大家提供了一个更充分应用抗血小板药物的空间，尤其对药物洗脱支架内血栓形成的预防具有更大的优势。但在年龄较高（＞75岁）、体重较轻（＜60公斤）或有脑卒中病史的患者，因出血性风险较高，普拉格雷应慎用或禁用。另外，在3月份美国奥兰多召开的ACC会议上公布的有关抗血小板药循证医学方面的最新研究——ACTIVE-A研究。ACTIVE-A研究对不适合应用华法林的房颤患者比较氯吡格雷和阿司匹林双联抗血小板药与单纯阿司匹林的效果，随访时间平均3年，结果证实双联抗血小板药比单纯阿司匹林可以将卒中发生率降低28%。有专家预测，这个试验的结果可能会为将来房颤的抗凝治疗指南的更新提供一些依据。
医心：王教授，您作为我国心血管领域的专家，为全国介入心脏病学论坛的筹备做了大量工作，请您通过“医心网”对介入论坛的发展和前景做一个简单的展望。
王教授：霍勇教授常说，介入论坛是中国医生自己的会议，我们需要借鉴国外的经验和循证医学的依据。但更重要的是希望国内心血管医生能通过这个平台，结合中国的国情、医疗的现状和实际工作中的亲身体会进行沟通和交流，把循证依据更好的应用到实际工作中。介入论坛会继续围绕“沟通、交流、规范化”的宗旨，将国外的信息及国内同行的经验共同传递给大家。
医心：感谢王贵松教授在百忙之中接受医心网的采访。祝您参会愉快！
来源： 医心网
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