Efficacy and safety of different ticagrelor regimens versus clopidogrel in patients with coronary artery disease: a retrospective multicenter study (SUPERIOR)
Efficacy and safety of different ticagrelor regimens versus clopidogrel in patients with coronary artery disease: a retrospective multicenter study (SUPERIOR)
复制标题
不同替格瑞洛方案与氯吡格雷治疗冠心病患者的疗效和安全性：一项回顾性多中心研究（优越）
DOI：
10.1080/09537104.2020.1732328
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发表时间：
2020-02-25
期刊：
影响因子：
3.3
通讯作者：
Li, Yue
中科院分区：
文献类型：
--
作者：
Shi, Jing;He, Meijiao;Li, Yue
目前的指南支持替格瑞洛90 mg BID（T90 BID）双联抗血小板治疗，而不是氯吡格雷75 mg QD（C75 QD）联合阿司匹林治疗急性冠脉综合征。然而，替格瑞洛相关不良事件的风险增加促使对低剂量方案进行评估。本研究（NCT 03381742）回顾性分析了来自11家医院的3，043例接受C75 QD、T90 BID、替格瑞洛45 mg BID（T45 BID）或替格瑞洛90 mg QD（T90 QD）治疗的冠心病患者的数据。与C75 QD相比，T45 BID和T90 QD均显示出显著更高的抑制二磷酸腺苷诱导的血小板聚集（P < .0001）和更低的血小板-纤维蛋白凝块强度（P < .0001）。此外，与T90 BID相比，两种低剂量方案的轻微出血率低得多，P2 Y（12）受体反应性治疗窗内的患者比例显著较高。T45 BID和T90 QD之间替格瑞洛及其活性代谢物的血浆谷浓度无显著差异。在倾向评分匹配分析中观察到相似的疗效和安全性结局。总之，低剂量替格瑞洛方案（T45 BID或T90 QD）可能比C75 QD或T90 BID提供更有吸引力的获益-风险特征。
Current guidelines favor dual anti-platelet therapy with ticagrelor 90 mg BID (T90BID) over clopidogrel 75 mg QD (C75QD) in addition to aspirin for acute coronary syndrome. However, an increased risk of ticagrelor-related adverse events prompted the evaluation of low-dose regimens. This study (NCT03381742) retrospectively analyzed the data from 11 hospitals on 3,043 patients with coronary artery disease, who received C75QD, T90BID, ticagrelor 45 mg BID (T45BID), or ticagrelor 90 mg QD (T90QD). Compared with C75QD, both T45BID and T90QD showed significantly higher inhibition of platelet aggregation (P < .0001) and lower platelet-fibrin clot strength (P < .0001) induced by adenosine diphosphate. Furthermore, compared with T90BID, two low-dose regimens had a much lower minor bleeding rate and a significantly higher proportion of patients within the therapeutic window for P2Y(12) receptor reactivity. There were no significant differences between T45BID and T90QD in the trough plasma concentrations of ticagrelor and its active metabolite. Similar efficacy and safety outcomes were observed in the propensity score-matched analysis. In conclusion, the low-dose ticagrelor regimen, either T45BID or T90QD, may provide a more attractive benefit-risk profile than C75QD or T90BID.