Thomas Deepak, Giugliano Robert P
Cardiovascular Division, Brigham and Women's Hospital, Boston, MA 02115, USA.
Crit Pathw Cardiol. 2009 Mar;8(1):12-9. doi: 10.1097/HPC.0b013e318196bb46.
Antiplatelet therapy is one of the key initial therapeutic interventions to prevent thrombotic complications associated with percutaneous coronary intervention. Aspirin and the thienopyridines, clopidogrel, and ticlopidine, are the most widely used oral antiplatelet agents in patients with non-ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention. Recent data have demonstrated limitations with the currently approved dosing regimen of clopidogrel (loading dose, 300 mg; maintenance dose, 75 mg daily) in a significant number of patients during the first few hours-days of treatment (Gurbel et al, Circulation. 2003;107:2908-2913 and Lau et al, Circulation. 2004;109:166-171). To circumvent this problem, some centers use a higher loading dose of clopidogrel (600 mg). Prasugrel is a novel thienopyridine prodrug similar to clopidogrel and ticlopidine that is more efficiently metabolized to its active metabolite compared with the 2 older drugs, providing enhanced platelet inhibition with less intersubject variability. The Trial to Assess Improvement in Therapeutic Outcomes by Optimizing Platelet Inhibition With Prasugrel-Thrombolysis In Myocardial Infarction 38 (TRITON-TIMI 38) study was a phase 3, multicenter trial that studied prasugrel in comparison with Clopidogrel in patients with moderate-to-high-risk acute coronary syndromes. In this article, we discuss the findings of this major trial, review previously published literature that compares the 2 medications, and provide a clinical context for the potential role of prasugrel in practice.
抗血小板治疗是预防经皮冠状动脉介入治疗相关血栓并发症的关键初始治疗干预措施之一。阿司匹林以及噻吩吡啶类药物氯吡格雷和噻氯匹定，是接受经皮冠状动脉介入治疗的非ST段抬高型心肌梗死患者中使用最广泛的口服抗血小板药物。最近的数据表明，在治疗的最初数小时至数天内，相当一部分患者使用目前批准的氯吡格雷给药方案（负荷剂量300mg；维持剂量每日75mg）存在局限性（Gurbel等人，《循环》。2003年；107:2908 - 2913以及Lau等人，《循环》。2004年；109:166 - 171）。为规避这一问题，一些中心使用更高的氯吡格雷负荷剂量（600mg）。普拉格雷是一种新型噻吩吡啶前体药物，与氯吡格雷和噻氯匹定类似，与这两种较老的药物相比，它能更有效地代谢为其活性代谢物，可提供更强的血小板抑制作用，且个体间变异性更小。通过普拉格雷优化血小板抑制评估治疗结果改善 - 心肌梗死溶栓38（TRITON - TIMI 38）试验是一项3期多中心试验，研究了普拉格雷与氯吡格雷在中高危急性冠状动脉综合征患者中的疗效对比。在本文中，我们讨论了这项主要试验的结果，回顾了先前发表的比较这两种药物的文献，并为普拉格雷在实际应用中的潜在作用提供了临床背景。
