Switching from high-dose clopidogrel to prasugrel in ACS patients undergoing PCI: a single-center experience
Switching from high-dose clopidogrel to prasugrel in ACS patients undergoing PCI: a single-center experience
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接受 PCI 的 ACS 患者从大剂量氯吡格雷转为普拉格雷：单中心经验
DOI：
10.1007/s11239-013-1039-0
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发表时间：
2014
影响因子：
4
通讯作者：
P. Marino
中科院分区：
文献类型：
--
作者：
G. Luca;M. Verdoia;A. Schaffer;H. Suryapranata;G. Parodi;D. Antoniucci;P. Marino
研究表明，在接受冠状动脉成形术的急性冠脉综合征患者中，普拉格雷优于氯吡格雷。然而，到目前为止，关于冠状动脉血管成形术后从氯吡格雷转向普拉格雷的患者的数据报道很少。本研究的目的是评价大剂量氯吡格雷预处理的急性冠脉综合征患者接受经皮冠状动脉介入治疗后给予普拉格雷负荷剂量的安全性。从2010年5月至2011年12月，150例接受冠状动脉成形术并接受大剂量氯吡格雷预治疗的急性冠脉综合征患者在手术后不久切换为普拉格雷负荷剂量。他们按性别和年龄匹配(比例为1：2)，在2010年5月至2011年12月期间接受血管成形术并仅接受大剂量氯吡格雷治疗的300名ACS患者。收集所有的人口学、临床和血管造影资料。主要终点是30天随访时的主要出血并发症发生率(根据锐度试验定义)。次要终点为：TIMI大出血和轻微出血、明确的支架血栓形成、重大心脏不良事件(MACE)和净不良心脏事件(NACE)。两组患者表现出相似的基线人口学和临床特征。患者多为不稳定型心绞痛或非ST段抬高心肌梗死。几乎(约95%)患者均接受了经桡动脉入路手术。根据视力(2.0vs2.0%)和TIMI重大(0.7vs1.3%)的定义，主要出血并发症没有差异。两组患者术后30d的支架内血栓形成、MACE和NACE发生率无明显差异。我们的观察研究表明，接受氯吡格雷治疗的急性冠脉综合征患者在血管成形术后立即改用负荷剂量的普拉格雷似乎耐受性良好，没有明显的大出血增加的证据。未来肯定需要大规模的随机试验来证实这些发现。
Prasugrel has been shown to be superior to clopidogrel in the setting of ACS patients undergoing coronary angioplasty. However, few data have been reported so far on those patients who switch from clopidogrel to prasugrel after coronary angioplasty. Aim of the current study was to evaluate the safety of prasugrel loading dose administration in ACS patients undergoing PCI and preatreated with high-dose clopidogrel. From May 2010 to December 2011 150 ACS patients undergoing coronary angioplasty and pretreated with high-dose clopidogrel, were switched to prasugrel loading dose soon after the procedure. They were matched (ratio 1:2) according to sex and age with a group of 300 ACS patients undergoing angioplasty and treated with high-dose clopidogrel only from May 2010 to December 2011. All demographic clinical and angiographic were collected. Primary endpoint was the rate of major bleeding complications (according to ACUITY trial definition) at 30-day follow-up. Secondary endpoints were: TIMI major and minor bleeding, definite stent thrombosis, major adverse cardiac events (MACE) and Net adverse cardiac events (NACE) at 30-day follow-up. The two groups of patients showed similar baseline demographic, and clinical characteristics. Most of the patients had unstable angina or non-ST segment elevation myocardial infarction. Almost (about 95 %) all patients underwent radial approach. No difference was observed in major bleeding complications according to both ACUITY (2.0 vs 2.0 %) and TIMI Major (0.7 vs 1.3 %) definition. No difference between the two groups was observed in terms of in-stent thrombosis, MACE and NACE at 30-day follow-up. Our observational study showed that switching to prasugrel with loading dose soon after angioplasty among ACS patients who were pretreated with clopidogrel seems to be well tolerated without overt evidence of heightened major bleeding. Future large randomized trials are certainly needed to confirm these findings.