Motovska Zuzana, Widimsky Petr
Third Medical Faculty of Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic.
Vasc Health Risk Manag. 2009;5(1):475-81. doi: 10.2147/vhrm.s3969.
Dual oral antiplatelet therapy, aspirin plus thienopyridine, has permitted a rapid increase in the use of coronary intervention procedures. Clopidogrel is the thienopyridine of choice for dual antiplatelet therapy in patients treated with percutaneous coronary intervention. However, there are two issues with clopidogrel: (1) clopidogrel's antiplatelet activity is delayed because the drug needs to be metabolized into its active form and (2) variability in patient response to clopidogrel has been demonstrated. To overcome these shortcomings of clopidogrel, new more potent inhibitors of P2Y12 receptors, which have a more rapid onset of action have been introduced for clinical evaluation. This article is a nonexhaustive review of the literature and concentrates on prasugrel, a third-generation, oral thienopyridine. The purpose is to summarize the current knowledge about the benefits and risks of prasugrel and to outline the most prudent strategies for the drug's clinical use.
双联口服抗血小板治疗，即阿司匹林加噻吩并吡啶，使得冠状动脉介入手术的使用迅速增加。氯吡格雷是接受经皮冠状动脉介入治疗患者双联抗血小板治疗的首选噻吩并吡啶。然而，氯吡格雷存在两个问题：（1）氯吡格雷的抗血小板活性延迟，因为该药物需要代谢为其活性形式；（2）已证实患者对氯吡格雷的反应存在变异性。为克服氯吡格雷的这些缺点，已引入作用起效更快的新型更强效P2Y12受体抑制剂用于临床评估。本文是对文献的非详尽综述，重点关注第三代口服噻吩并吡啶普拉格雷。目的是总结关于普拉格雷益处和风险的当前知识，并概述该药物临床使用的最审慎策略。
