Norgard Nicholas B, Abu-Fadel Mazen
University at Buffalo, School of Pharmacy and Pharmaceutical Sciences, Buffalo, NY 14260, USA.
Vasc Health Risk Manag. 2009;5:873-82. doi: 10.2147/vhrm.s5699. Epub 2009 Nov 2.
Antiplatelet agents are the cornerstone of treatment for patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). Clopidogrel, when added to aspirin, has demonstrated considerable success at reducing thrombotic complications of ACS and/or PCI compared to aspirin alone and is standard of care for the management of patients with ACS and in patients undergoing PCI. Prasugrel is a novel thienopyridine antiplatelet agent recently approved for the treatment of patients with ACS undergoing PCI. Prasugrel provides greater and more consistent platelet inhibition than clopidogrel due to earlier and more extensive formation of its active metabolite. The enhanced platelet inhibition with prasugrel led to a reduction in major adverse cardiovascular events in patients with moderate to high risk ACS scheduled for PCI in the phase 3 TRITON-TIMI 38 trial. This benefit was seen more in patients suffering a STEMI and those with diabetes. However, this reduction in events was met with a significant increase in the risk of bleeding which overcame prasugrel's benefit in certain groups. Future studies with prasugrel are needed to determine its optimal utilization to minimize bleeding risks and evaluate its outcomes in ACS and safety profile in special patient populations.
抗血小板药物是接受经皮冠状动脉介入治疗（PCI）的急性冠状动脉综合征（ACS）患者治疗的基石。与单用阿司匹林相比，氯吡格雷联合阿司匹林在降低ACS和/或PCI的血栓形成并发症方面已取得显著成效，是ACS患者管理及接受PCI患者的标准治疗方法。普拉格雷是一种新型噻吩并吡啶类抗血小板药物，最近被批准用于治疗接受PCI的ACS患者。由于其活性代谢产物形成更早且更广泛，普拉格雷比氯吡格雷能提供更强且更持久的血小板抑制作用。在3期TRITON-TIMI 38试验中，对于计划接受PCI的中高危ACS患者，普拉格雷增强的血小板抑制作用使主要不良心血管事件减少。这种益处在ST段抬高型心肌梗死（STEMI）患者和糖尿病患者中更为明显。然而，事件的减少伴随着出血风险的显著增加，这在某些人群中抵消了普拉格雷的益处。需要对普拉格雷进行进一步研究，以确定其最佳使用方法，将出血风险降至最低，并评估其在ACS中的疗效以及在特殊患者群体中的安全性。
