Transferring from clopidogrel loading dose to prasugrel loading dose in acute coronary syndrome patients
Transferring from clopidogrel loading dose to prasugrel loading dose in acute coronary syndrome patients
复制标题
急性冠脉综合征患者从氯吡格雷负荷剂量转为普拉格雷负荷剂量
DOI：
--
复制
发表时间：
2014
影响因子：
6.7
通讯作者：
D. Angiolillo
中科院分区：
文献类型：
--
作者：
J. Diodati;J. Saucedo;T. Cardillo;J. Jakubowski;C. Henneges;M. Effron;Fred R. Lipkin;J. Walker;S. Duvvuru;S. Sundseth;H. Fisher;D. Angiolillo
治疗期间高血小板反应性（HPR）已被确定为缺血事件的独立风险因素。随机、双盲、TRIPLET试验包括一项预先定义的比较急性冠状动脉综合征（ACS）患者接受经皮冠状动脉介入治疗（PCI）后，在随后的普拉格雷60 mg或30 mg LD之前立即给予安慰剂/600 mg氯吡格雷负荷剂量（LD）后的HPR。在安慰剂/氯吡格雷LD后24小时内（普拉格雷LD前即刻）和普拉格雷LD后2、6、24、72小时，使用VerifyNow® P2 Y12测定法（P2 Y12反应单位，PRU）评估血小板反应性。还评估了CYP 2C 19预测代谢者表型（快代谢者[EM]和还原代谢者[RM]）对HPR状态的影响。氯吡格雷LD联合给药组中，氯吡格雷LD给药后（普拉格雷LD给药前）的HPR（PRU ≥240）为58.5%。按时间分层时，氯吡格雷和普拉格雷LD之间无显著差异（≤6 h vs >6 h）。普拉格雷LD联合组第二次负荷剂量后6小时，HPR为7.1%，72小时HPR为0%。在任何时间点，无论是否在氯吡格雷600 mg LD之前进行普拉格雷LD治疗，CYP 2C 19基因型对药效学（PD）反应均无显著影响。总之，在本研究中，无论代谢者状态如何，拟行PCI的ACS患者在接受氯吡格雷600 mg LD后HPR的发生率较高。当添加普拉格雷LD时，HPR在6 h时显著降低，并且在72 h时未观察到。
Summary High on-treatment platelet reactivity (HPR) has been identified as an independent risk factor for ischaemic events. The randomised, doubleblind, TRIPLET trial included a pre-defined comparison of HPR in acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI) following a placebo/600-mg clopidogrel loading dose (LD) immediately before a subsequent prasugrel 60-mg or 30-mg LD. Platelet reactivity was assessed using the VerifyNow® P2Y12 assay (P2Y12 Reaction Units, PRU) within 24 hours (h) following the placebo/clopidogrel LD (immediately prior to prasugrel LD), and at 2, 6, 24, 72 h following prasugrel LDs. The impact of CYP2C19 predicted metaboliser phenotype (extensive metaboliser [EM] and reduced metabolisers [RM]) on HPR status was also assessed. HPR (PRU ≥240) following the clopidogrel LD (prior to the prasugrel LD) was 58.5% in the combined clopidogrel LD groups. No significant difference was noted when stratified by time between the clopidogrel and prasugrel LDs (≤6 hs vs >6 h). At 6 h following the 2nd loading dose in the combined prasugrel LD groups, HPR was 7.1%, with 0% HPR by 72 h. There was no significant effect of CYP2C19 genotype on pharmacodynamic (PD) response following either prasugrel LD treatments at any time point, regardless of whether it was preceded by a clopidogrel 600-mg LD. In conclusion, in this study, patients with ACS intended for PCI showed a high prevalence of HPR after clopidogrel 600-mg LD regardless of metaboliser status. When prasugrel LD was added, HPR decreased substantially by 6 h, and was not seen by 72 h.
影响因子：
158.5
作者：
Mega, Jessica L.;Close, Sandra L.;Sabatine, Marc S.
通讯作者：
Sabatine, Marc S.