Department of Pharmacy, Hartford Hospital, Hartford, Connecticut 06102, USA.
Pharmacotherapy. 2009 Dec;29(12):1441-51. doi: 10.1592/phco.29.12.1441.
Thienopyridine antiplatelet drugs have been used for 15 years for the prevention of coronary stent thrombosis in patients undergoing percutaneous coronary intervention with stent placement. Ticlopidine, the first approved thienopyridine, has in large part been replaced by clopidogrel, a more potent and better tolerated thienopyridine. Now, prasugrel, the newest agent, is currently available for use in the United States. Although prasugrel is similar to clopidogrel, it is about 10 times more potent and has a quicker onset of action. Data from the largest trial comparing clopidogrel and prasugrel indicate that this increased potency and quicker onset of prasugrel equate to a reduction in major adverse cardiovascular events, although higher rates of major bleeding were reported. Prasugrel also differs from clopidogrel in that it may be less prone to drug-drug interactions and patient nonresponsiveness, although further research is needed in both of these areas. Given the totality of data available, prasugrel appears to be a promising treatment option for patients with acute coronary syndromes who are undergoing percutaneous coronary interventions.
噻吩吡啶类抗血小板药物已在临床上应用 15 年，用于预防经皮冠状动脉介入治疗（PCI）置入支架后发生的冠状动脉支架内血栓形成。噻吩吡啶类药物中的第一个被批准用于临床的药物是噻氯匹定，目前已大部分被作用更强、耐受性更好的氯吡格雷所取代。目前，在美国已可应用新型噻吩吡啶类药物普拉格雷。尽管普拉格雷与氯吡格雷相似，但它的作用强度约为氯吡格雷的 10 倍，起效更快。比较氯吡格雷和普拉格雷的最大临床试验的数据表明，普拉格雷这种更强的作用强度和更快的起效时间可降低主要不良心血管事件的发生，但同时也报告了更高的大出血发生率。与氯吡格雷不同，普拉格雷可能较少发生药物-药物相互作用和患者无反应性，尽管这两方面都需要进一步研究。鉴于现有数据的全面性，普拉格雷似乎是接受经皮冠状动脉介入治疗的急性冠状动脉综合征患者的一种很有前途的治疗选择。
