Chất đối kháng Glycoprotein IIb/IIIa trong đột quỵ thiếu máu cục bộ cấp tính

Drugs - Tập 68 - Trang 1019-1028 - 2012
Pitchaiah Mandava1, Perumal Thiagarajan2, Thomas A. Kent1
1Michael E. DeBakey VA Medical Center and Department of Neurology, Baylor College of Medicine, Houston, USA
2Department of Pathology, Baylor College of Medicine, Houston USA

Tóm tắt

Các thụ thể glycoprotein (GP) IIb/IIIa trên bề mặt tiểu cầu đóng vai trò quan trọng trong cơ chế đông máu. Các chất đối kháng GP IIb/IIIa dùng đường tiêm tĩnh mạch như abciximab, tirofiban và eptifibatide đã cho thấy hiệu quả trong hội chứng mạch vành cấp tính khi được kết hợp với heparin, aspirin, clopidogrel và can thiệp mạch vành qua da. Kết quả trên không nhất quán trong trường hợp đột quỵ thiếu máu cấp tính. Dữ liệu tiền lâm sàng hỗ trợ lợi ích tiềm năng của các tác nhân này cả trong vi tuần hoàn và trong việc hỗ trợ tiêu huyết khối. Trong khi các thử nghiệm giai đoạn I và II về abciximab như tác nhân duy nhất với liều lượng tương đương với những liều used trong hội chứng mạch vành cho thấy hứa hẹn, thì thử nghiệm giai đoạn III xác định đã bị bỏ dở do tỷ lệ lợi ích-rủi ro không thuận lợi. Các phép đo ức chế tiểu cầu sơ bộ mới từ nhóm nghiên cứu của chúng tôi cho thấy rằng liều lượng tim mạch có thể quá cao đối với bệnh nhân bị đột quỵ. Việc khám phá các liều lượng thấp hơn của abciximab và tăng cường bằng heparin dựa vào trọng lượng trong thời gian giới hạn cùng với việc đo lường ức chế sự kết tập tiểu cầu vẫn đang được tiến hành ở quy mô nhỏ hơn. Hiện tại, việc sử dụng phổ biến nhất của các chất đối kháng GP IIb/IIIa trong trường hợp đột quỵ là như các tác nhân hỗ trợ cho tiêu huyết khối theo đường tĩnh mạch và động mạch. Sự tiến bộ đáng kể có thể yêu cầu một hiểu biết tốt hơn về cơ chế hành động và dược lý độc đáo của các chất đối kháng GP IIb/IIIa trong đột quỵ thiếu máu.

Từ khóa

#Glycoprotein IIb/IIIa #chất đối kháng #đột quỵ thiếu máu #tiêu huyết khối #heparin #tiểu cầu

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