血小板阻害 カングレラーとクラッシュされたチカグレラーで,STセグメント上昇性心筋梗塞の患者で,初回皮質冠動脈手術を受ける
Francesco Franchi1, Fabiana Rollini1, Andrea Rivas1
1Division of Cardiology, University of Florida College of Medicine-Jacksonville.
Circulation
|January 12, 2019
まとめ
Cangrelorは,TCAとの薬物相互作用を示さず,一次性皮膚経冠動脈介入中にP2Y12阻害のギャップを効果的に埋める. この戦略は,STセグメント上昇性心筋梗塞患者の血小板抑制を改善します.
科学分野:
- 心臓病科
- 薬理学について
- 介入心臓科
背景:
- 経口投与のP2Y12抗剤は,P-PCIを受けたST上昇心筋梗塞の患者で,血小板抑制が遅れていることを示している.
- この遅延は,血栓性合併症の窓を作り出し,ペリ-P-PCI血小板抑制の戦略を改善する必要があります.
- 静脈内投与のP2Y12阻害剤であるCangrelorは,迅速かつ強力な抗血小板効果を発揮するが,P- PCIにおけるチカグレロとの組み合わせについてはさらなる研究が必要である.
研究 の 目的:
- P- PCIを受けた患者でカングレロールとチカグレロールを併用した薬動学的効果を評価する.
- 移行期間にカングレロールとチカグレロールの潜在的薬物相互作用を評価する
主な方法:
- 予備的,ランダム化,ダブルブラインド,プラセボ対照薬動学的研究.
- P- PCIを受けた50人の患者は,カングレロールまたはプラセボとチカグレロールの負荷用量を受けた.
- 血小板阻害はP2Y12反応単位 (VerifyNow) と血小板反応指数 (血管拡張剤で刺激されたフォスフォタンパク質) を用いて8つの時間点で測定された.
主要な成果:
- Cangrelorは,注入後5分からP2Y12反応単位を著しく減少させ,注入中に持続した (P< 0. 001).
- 治療中の高血小板反応率はカングレラ群では低かった.
- カングレロールとチカグレロールの間の薬物相互作用を示唆する,注射中止後に血小板の反応性における有意な差異は観察されなかった.
結論:
- Cangrelorは,P- PCIにおけるチカグレロのような経口P2Y12阻害剤から移行する際に,血小板抑制のギャップを効果的に埋めます.
- クラッシュされたチカグレロとカングレロの併用は安全で,薬剤間相互作用はない.
- これらの薬動学的発見の臨床的影響を確認するために,さらなる臨床試験が必要である.
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