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血小板功能在延长的普拉苏格雷尔和克洛皮多格雷尔治疗患者的血小板功能与ACS治疗没有再血管化:TRILOGY ACS血小板功能副研究
Paul A Gurbel1, David Erlinge, E Magnus Ohman
1Sinai Center for Thrombosis Research, Baltimore, Maryland, USA.
JAMA
|November 3, 2012
概括
在急性冠状动脉综合征 (ACS) 患者中,普拉苏格勒的血小板反应性低于克洛皮多格雷尔. 然而,这两种药物之间没有观察到主要心血管不良事件的显著差异,也没有发现血小板反应和结果之间的明显联系.
科学领域:
- 心脏病学 心脏病学
- 药理学 药理学是指药理学的学科.
- 临床试验 临床试验
背景情况:
- 急性冠状动脉综合征 (ACS) 患者的血小板功能测试结果与临床结果之间的关系在没有再血管化的情况下进行医学治疗仍然不清楚.
- 了解这些关系对于优化ACS患者的抗血小板治疗至关重要.
研究的目的:
- 为了比较克洛皮多格雷尔和普拉苏格雷尔之间的血小板反应性,在接受医学治疗的ACS患者中.
- 评估该患者群体中血小板反应性和临床结果之间的关联.
主要方法:
- 在 TRILOGY ACS 试验 (2008-2011) 中,注册了医疗管理不稳定的心痛或非ST段升高心肌梗塞的患者.
- 一项血小板功能子研究评估了在不同时间点接受阿司匹林与克洛皮多格雷尔或普拉苏格雷尔治疗的患者的P2Y12反应单位 (PRU).
- 主要疗效终点是30个月内心血管死亡,心肌梗塞或中风的复合结果.
主要成果:
- 与克洛皮多格雷尔相比,prasugrel与不同患者亚组 (年龄,体重) 的PRU值明显较低有关.
- 尽管血小板反应性有差异,但30个月后在普拉苏格勒和克洛皮多格勒组之间的初级疗效终点中没有发现显著差异 (17.2%与18.9%,P = .29).
- 在连续的PRU值或高的治疗前血小板反应性和初级疗效终点的发生之间没有明显的关系.
结论:
- 在医疗管理的ACS患者中,与克洛皮多格雷尔相比,普拉苏格雷尔始终降低了血小板活性,无论患者的特征或剂量如何.
- 观察到的血小板反应性的差异并没有转化为两种药物之间主要心血管不良事件的显著差异.
- 通过PRU测量的血小板反应性,在本研究人群中没有显示出与缺血性结局的显著关联.
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