Armani Annemarie M
South Shore Internal Medicine Associates, Milton, MA, USA.
Crit Pathw Cardiol. 2010 Dec;9(4):199-202. doi: 10.1097/HPC.0b013e3181fed221.
As cardiovascular disease remains the major cause of death in the United States, millions of Americans present to our hospitals with acute coronary syndromes. Recommendations for the use of thienopyridines are jointly agreed upon by the American College of Cardiology and the American Heart Association in their guidelines, in the setting of ST-segment elevation myocardial infarction (STEMI), non-STEMI, whether in the setting of percutaneous coronary intervention or not. The newly available thienopyridine prasugrel appears to be a promising advance in antiplatelet therapy with more potent antiplatelet effects and a lower incidence of interpatient variability in antiplatelet response than current options. Recent phase III data demonstrate that prasugrel is superior to clopidogrel in preventing cardiovascular morbidity and mortality in patients with acute coronary syndrome undergoing percutaneous coronary intervention, although with a greater risk of bleeding. As more becomes understood regarding clopidogrel resistance, concomitant use of proton pump inhibitors, pharmacogenomics, and the impending need for genomic assays in the near future, as with other anticoagulant therapies, appropriate patient selection for treatment with prasugrel can guarantee necessary benefit with an acceptable risk of bleeding.
由于心血管疾病仍是美国主要的死亡原因，数以百万计的美国人因急性冠状动脉综合征前来我们的医院就诊。美国心脏病学会和美国心脏协会在其指南中就噻吩并吡啶类药物的使用建议达成了共识，这些建议适用于ST段抬高型心肌梗死（STEMI）、非STEMI患者，无论是否进行经皮冠状动脉介入治疗。新上市的噻吩并吡啶类药物普拉格雷似乎是抗血小板治疗方面一项有前景的进展，其抗血小板作用更强，与现有药物相比，患者间抗血小板反应的变异性发生率更低。近期的III期数据表明，在接受经皮冠状动脉介入治疗的急性冠状动脉综合征患者中，普拉格雷在预防心血管疾病发病率和死亡率方面优于氯吡格雷，尽管出血风险更高。随着对氯吡格雷抵抗、质子泵抑制剂的联合使用、药物基因组学的了解越来越多，以及在不久的将来与其他抗凝治疗一样对基因组检测的迫切需求，为普拉格雷治疗选择合适的患者可以在可接受的出血风险下保证必要的获益。
