Jerrold Levy 教授：美国埃默里大学医学院麻醉学教授，美国心脏病学学会资深会员。研究领域：止血，急性炎症和过敏反应，心血管药理学，血管生理学 。
概要
体外研究中氯吡格雷药物抵抗发生率为30%~40%，支架内血栓形成可能与药物抵抗有关。因此，应用氯吡格雷时，有必要监测血小板功能。而新型抗血小板药物如普拉格雷和替卡瑞洛的药物抵抗非常少见，因此，血小板功能检测并非必要。
手术患者术前往往需要行血小板功能的检测，因为检测结果可反映抗血小板治疗的效果，并为术前停用抗血小板药物提供依据。推荐择期手术前5天停用氯吡格雷，术前7天停用普拉格雷，如果是紧急手术，停用时间可以缩短。另外，氯吡格雷治疗时患者对药物的反应存在个体差异，而其他药物则无此情况，这也值得研究。
新的血小板功能检测方法如VerifyNow是一种用于评估个体血小板功能的检测方法。已经有很多研究证实了这种方法的有效性。对于术后或创伤后正在出血的患者而言，存在凝血和稀释效应时血小板功能检测结果并不准确。但是，在根据血小板功能决定是否进行手术的患者中，我认为VerifyNow方法是一种非常有效的预测性检测。
There are reasonably better tests in 2012 that allow us to assess platelet function and platelet inhibition. There is one agent in particular that requires this: clopidogrel. If we look at the in-vitro clopidogrel resistance， which is about 30%~40%， my opinion has been that stent thrombosis may often represent clopidogrel resistance. The newer agents， such as prasugrel and ticagrelor， do not have this resistance issue. If you are using clopidogrel， it is important to consider testing platelet function， even though these tests are used with other agents as well. With prasugrel and ticagrelor there seems to be much less need for testing because resistance issues are relatively rare. The flip side is that these platelet function tests are often used when patients require surgery or procedural events， because they give you an idea of the degree of anti-platelet function and the concept of stopping it before any procedural events. The recommendations are 5 days with clopidogrel for elective surgery， 7 days with prasugrel， and maybe less with emergency surgery. With clopidogrel， there is variability in responsiveness which you do not have with the other agents. There are some interesting perspectives here. VerifyNow， which I have worked on， is an excellent platelet function test. It has many publications regarding its usefulness. However， the tests are not effective in a patient who is bleeding， after surgery， trauma， or a major event when you have all the coagulation and dilutional effects. Yet as a predictive test to determine the level of platelet function and whether or not to proceed to procedural events， I think the tests are very useful. VerifyNow was actually developed by a Dr. Barry Coller， the Physician-in-Chief at the Rockefeller Institute who also developed abciximab. It is a very interesting test， but all coagulation tests have potential limitations. There are other tests， but to me， this has been the most extensively studied in this type of patient population， specifically with the use of thienopyradines.