Study design and rationale of a comparison of prasugrel and clopidogrel in medically managed patients with unstable angina/non-ST-segment elevation myocardial infarction: The TaRgeted platelet Inhibition to cLarify the Optimal strateGy to medicallY manage Acute Coronary Syndromes (TRILOGY ACS) trial
Study design and rationale of a comparison of prasugrel and clopidogrel in medically managed patients with unstable angina/non-ST-segment elevation myocardial infarction: The TaRgeted platelet Inhibition to cLarify the Optimal strateGy to medicallY manage Acute Coronary Syndromes (TRILOGY ACS) trial
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DOI：
10.1016/j.ahj.2010.04.022
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发表时间：
2010-07-01
影响因子：
4.8
通讯作者：
Ohman, E. Magnus
中科院分区：
文献类型：
--
作者：
Chin, Chee Tang;Roe, Matthew T.;Ohman, E. Magnus
实践指南建议非ST段抬高急性冠状动脉综合征（NSTE ACS）患者采用阿司匹林和氯吡格雷双重抗血小板治疗，而不考虑住院管理策略。Prasugrel-一种噻吩并吡啶腺苷二磷酸受体拮抗剂，提供比氯吡格雷更高和更低的血小板抑制水平-已被证明在治疗接受经皮冠状动脉介入治疗的ACS患者时有益。然而，对于高风险、经药物管理的NSTE ACS患者，抗血小板治疗的最佳方法仍不确定，因为这些患者尚未成为这些治疗的既往临床试验的重点。TRILOGY ACS是一项III期、随机、双盲试验，入组了约10，300例在10天内出现不稳定型心绞痛或NSTE心肌梗死的NSTE ACS患者，这些患者预期不会因其索引事件接受血运重建术。患者将被随机分配至普拉格雷+阿司匹林组和氯吡格雷+阿司匹林组，中位持续时间为18个月。减少老年患者（年龄≥ 75岁）和体重较轻患者的普拉格雷维持剂量
Practice guidelines recommend dual antiplatelet therapy with aspirin and clopidogrel for patients with non-ST-segment elevation acute coronary syndromes (NSTE ACS) regardless of in-hospital management strategy. Prasugrel-a thienopyridine adenosine diphosphate receptor antagonist that provides higher and less variable levels of platelet inhibition than clopidogrel-has demonstrated benefit when used to treat ACS patients undergoing percutaneous coronary intervention. However, the optimal approach to antiplatelet therapy for high-risk, medically managed NSTE ACS patients remains uncertain, as these patients have not been the focus of previous clinical trials of these therapies. TRILOGY ACS is a phase 3, randomized, double-blind trial enrolling approximately 10,300 NSTE ACS patients within 10 days of presentation with either unstable angina or NSTE myocardial infarction who are not intended to undergo revascularization procedures for their index event. Patients will be randomly allocated to prasugrel + aspirin versus clopidogrel + aspirin for a median duration of 18 months. A reduction in the maintenance dose of prasugrel for elderly patients (age >= 75 years) and those with body weight