普拉苏格勒与克洛皮多格勒相比,用于ST升高心肌梗塞 (TRITON-TIMI 38) 的皮肤冠状动脉干预患者:双盲,随机对照试验
Gilles Montalescot1, Stephen D Wiviott, Eugene Braunwald
1Institute of Cardiology, INSERM U856, Université Paris 6, Pitié-Salpêtrière Hospital (AP-HP), Paris, France.
Lancet (London, England)
|March 3, 2009
概括
与克洛皮多格雷尔相比,prasugrel显著降低了经皮冠状动脉干预 (PCI) 的ST升高心肌梗塞 (STEMI) 患者的缺血事件. 这种强大的抗血小板疗法显示出更好的疗效,但没有显著增加主要出血事件.
科学领域:
- 心脏病学 心脏病学
- 药理学 药理学 是一个学科.
背景情况:
- ST-升高心肌梗塞 (STEMI) 管理通常涉及机械转注与支架.
- 双重抗血小板治疗,通常是阿司匹林和克洛皮多格雷尔,是PCI后的标准治疗.
- 普拉苏格雷尔为克洛皮多格雷尔提供了一种强效和快速起作用的替代品.
研究的目的:
- 为了比较普拉苏格勒与克洛皮多格勒在接受PCI的STEMI患者的疗效和安全性.
- 在这个患者群体中评估普拉苏格雷尔作为克洛皮多格雷尔的潜在替代品.
主要方法:
- 一个双盲,随机对照试验,涉及3534名STEMI患者在30个国家的707个地点.
- 参与者接受了普拉苏格勒 (60毫克加载,10毫克维护) 或克洛皮多格勒 (300毫克加载,75毫克维护).
- 主要终点:心血管死亡,非致命的心肌梗塞或非致命中风的组合,评估时间长达15个月.
主要成果:
- 普拉苏格勒显著降低了30天 (6.5%对9.5%,p=0.0017) 和15个月 (10.0%对12.4%,p=0.0221) 的初级终点.
- 关键的次要终点,包括紧急目标血管再血管和支架血栓形成,也被普拉苏格勒显著降低.
- 两组之间没有观察到与CABG手术无关的大型出血的显著差异;然而,在CABG后的大型出血在prasugrel增加.
结论:
- 在接受PCI的STEMI患者中,prasugrel在预防缺血事件方面表现出比克洛皮多格雷尔更高的疗效.
- 该研究表明,普拉苏格勒对于STEMI患者来说是一个更有效的选择,具有可比的整体出血风险概况,除了CABG后出血.
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