关于长期抗血小板治疗的困惑与思考
Confusion and thinking about long-term antiplatelet therapy

在血栓性疾病的二级预防中，长期抗血小板治疗除了有一定程度的出血风险外，还可能有其他副作用：如可能会促使动脉粥样硬化加重、诱发抗血小板药物抵抗、撤药反弹、抑制受损内皮和组织修复、长期用药依从性低等。建议对长期抗血小板治疗做些理念和策略上的调整：如将患者分层管理，对高危和低危患者分别采用不同的抗血小板治疗方案；长期用药可采用多种抗血小板药物交替使用，以维持疗效；减药停药要缓慢；二级预防的重点应从抗血小板治疗转向减少引起内皮损伤和血小板活化的因素上来；要加强长期抗血小板治疗对动脉粥样硬化影响的研究。
In the secondary prevention of thrombotic disease, long-term antiplatelet therapy maybe leads to many sideeffects, for example, deterioration of atherosclerosis, drug resistance, withdrawal recurrence, inhibition of endothelial andtissue repairing, and lower medication adherence as well as bleeding in some cases. So it is suggested here that some ideasand strategies about long-term antiplatelet therapy should be adjusted. For instance, we can do risk stratification aboutrecurrence of thrombotic disease, and then adopt different antiplatelet therapy plans for the high-risk patients and lowriskpatients; in order to maintain curative effect, we can use one to three kinds of antiplatelet drugs alternately for longtermmedication; drug withdrawal should be slow so as to prevent withdrawal rebound; the focus of secondary preventionof thrombotic disease should be turned from antiplatelet therapy to eliminating the causes of endothelial injury andplatelet activation; at last, we should strengthen the research work about the effects of long-term antiplatelet therapy onatherosclerosis