《国际循环》：当面对氯吡格雷抵抗时，临床医生要做的是什么？　

　    <International Circulation> :What is the clinician to do when faced with clopidogrel resistance?
 

　　Dr Weitz：第一点是，可能我们不应该进行增强血小板反应的检测，因为我们还不知道它的用途。我们昨天刚在AHA看过GRAVITAS试验的结果，他们在试验中纳入介入后血小板反应增强的患者并将他们随机分配接受双倍剂量氯吡格雷或常规剂量氯吡格雷，两组结果并无差异。至于目前通过观察血小板反应性进行基因型检测，我认为，这不是黄金时间，而且我还认为它不应当开展，因为我们不知道用它做什么。

　　Dr Weitz: The first point to make is that maybe we shouldn’t be testing for increased platelet reactivity because we don’t know what to do with it yet. We saw the results of the GRAVITAS trial at the AHA just yesterday where they took patients with increased platelet reactivity after intervention and randomized them to double-dose clopidogrel or usual clopidogrel doses; there was no difference in clinical outcome.  Therefore， to my mind， testing for phenotype by measuring platelet reactivity is not yet ready for prime time.  I don’t think it should be done yet because we don’t know what to do with the information.  As of now， there is no evidence that intervention improves clinical outcome.

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