Capranzano Piera, Ferreiro Jose Luis, Angiolillo Dominick J
Division of Cardiology, University of Florida College of Medicine-Jacksonville, Jacksonville, FL 32209, USA.
Expert Rev Cardiovasc Ther. 2009 Apr;7(4):361-9. doi: 10.1586/erc.09.4.
Currently, dual antiplatelet therapy with aspirin and clopidogrel represents the key treatment strategy for the prevention of ischemic events in patients with acute coronary syndrome (ACS) and/or undergoing percutaneous coronary intervention (PCI). However, there is a broad inter-individual response variability to such treatment strategy, and a considerable number of patients persist with inadequate platelet inhibition, which has been associated with an increased risk of ischemic events. Overall, these findings underscore the need for novel antiplatelet agents able to achieve greater platelet inhibition; this can potentially reduce ischemic event rates. Prasugrel (CS-747; LY 640315), a novel third-generation oral thienopyridine, is a specific, irreversible antagonist of the platelet adenosine diphosphate P2Y(12) receptor. Laboratory studies have shown prasugrel to be associated with more prompt, potent and predictable degrees of platelet inhibition compared with clopidogrel. In a large-scale clinical study, which was comprised of high-risk ACS patients undergoing PCI, prasugrel was shown to significantly reduce the short- and long-term risk of ischemic events, including stent thrombosis. However, such significant reduction in ischemic events occurred at the expense of a higher risk of bleeding. Recent clinical trial data analyses have led to a better understanding of the efficacy and safety of prasugrel. This article reviews the currently available data regarding the efficacy and safety of prasugrel in ACS patients.
目前，阿司匹林和氯吡格雷联合抗血小板治疗是预防急性冠状动脉综合征（ACS）患者和/或接受经皮冠状动脉介入治疗（PCI）患者缺血事件的关键治疗策略。然而，个体对这种治疗策略的反应存在很大差异，相当数量的患者血小板抑制效果仍不理想，这与缺血事件风险增加有关。总体而言，这些发现凸显了对能够实现更强血小板抑制的新型抗血小板药物的需求；这有可能降低缺血事件发生率。普拉格雷（CS - 747；LY 640315）是一种新型第三代口服噻吩并吡啶类药物，是血小板二磷酸腺苷P2Y(12)受体的特异性、不可逆拮抗剂。实验室研究表明，与氯吡格雷相比，普拉格雷能更迅速、强效且可预测地抑制血小板。在一项由接受PCI的高危ACS患者组成的大规模临床研究中，普拉格雷被证明能显著降低缺血事件的短期和长期风险，包括支架血栓形成。然而，缺血事件的显著减少是以更高的出血风险为代价的。最近的临床试验数据分析使人们对普拉格雷的疗效和安全性有了更好的理解。本文综述了目前关于普拉格雷在ACS患者中疗效和安全性的可用数据。
