MEDIX, God. 22 Br. 121/122  •  Autorski pregled  •  Interna medicina HR ENG

Osobitosti otpornosti na antitrombocitne lijekove u bolesnika s akutnim koronarnim sindromomCharacteristics of antiplatelet therapy resistance in patients with acute coronary syndrome

Jure Samardžić, Hrvoje Jurin, Ivo Planinc, Marijan Pašalić, Jana Ljubas Maček, Boško Skorić, Davor Miličić

Primjena antitrombocitnih lijekova, uz revaskularizaciju, temelj je za uspješno liječenje bolesnika s akutnim koronarnim sindromom. Unatoč suvremenom i pravodobnom liječenju u bolesnika s akutnom ishemijom srca mogući su novi aterotrombotični događaji. Razvoj novih antitrombocitnih lijekova, boljih potpornica (stent) i poboljšanja zbrinjavanja tih bolesnika, nisu uspjeli eliminirati pojavu rekurentnih ishemijskih događaja nakon inicijalnoga koronarnog incidenta. Borba s tim velikim javnozdravstvenim problemom mora se voditi na više razina preventivne, kurativne i rehabilitacijske medicine. U vremenu individualiziranoga pristupa liječenju, potrebne su učinkovite strategije prevencije i liječenja bolesnika s akutnim koronarnim sindromom kako bi se smanjio rizik za nove ishemijske događaje, a rizik za krvarenje ne bi znatno povećao. Izazovi u antitrombocitnoj farmakoterapiji tih bolesnika s vremenom će rasti zbog starenja stanovništva, kompleksnosti obolijevanja i komorbiditeta.

Ključne riječi:
akutni koronarni sindrom; antitrombocitni lijekovi; individualizirana terapija; infarkt miokarda; klinički ishodi

Članak u cijelosti pročitajte u tiskanom izdanju MEDIX, God. 22 Br. 121/122

Antiplatelet therapy and revascularization are essential for the successful treatment of patients with acute coronary syndrome. Despite modern and timely medical treatment a certain proportion of patients with acute coronary ischemia will develop new atherothrombotic events. The development of new antiplatelet drugs, improvement in stent technology and care for these patients failed to eliminate the recurrence of ischemic events after the initial coronary incident. The struggle with this immense public health problem must be conducted on more levels in preventive, curative and rehabilitative medicine. At the time of the individualized approach to the treatment, there is a need for effective strategies for prevention and treatment of patients with acute coronary syndrome in order to reduce the risk of new ischemic events, without significantly increasing the risk of bleeding. Challenges in antiplatelet pharmacotherapy of these patients will eventually increase due to the aging population, the complexity of the disease and comorbidities.

Key words:
acute coronary syndrome; myocardial infarction; precision medicine; platelet aggregation inhibitors; treatment outcome