Department of Pharmacy Practice, School of Pharmacy, Concordia University Wisconsin, Mequon, WI, USA.
Ann Pharmacother. 2011 Oct;45(10):e54. doi: 10.1345/aph.1Q287. Epub 2011 Sep 6.
To report a case of successful use of prasugrel following percutaneous coronary intervention with placement of a bare metal stent in a patient with a documented hypersensitivity reaction to clopidogrel.
A 61-year-old male with a history of coronary artery disease with coronary stent placement presented with ST-elevation myocardial infarction. The patient had developed Stephens-Johnson syndrome 6 years earlier following clopidogrel administration, characterized by erythematous plaques and subsequent desquamation of the hands and feet; clopidogrel was discontinued and he was subsequently treated with ticlopidine in addition to aspirin. The third-generation thienopyridine prasugrel was initiated as a therapeutic alternative to clopidogrel after placement of a bare metal stent; a 60-mg dose was administered after extubation, followed by 10 mg/day. No signs of allergic reaction were observed in the days, weeks, and months following administration.
Thienopyridines, specifically clopidogrel, are the standard of care for prevention of coronary stent thrombosis; however, there are few data available on cross-hypersensitivity between these agents. One study demonstrated that 27% of patients who developed an allergic or hematologic reaction to clopidogrel developed a similar reaction to ticlopidine. Other therapeutic options for patients with clopidogrel hypersensitivity who are undergoing a percutaneous coronary intervention with stent placement include clopidogrel desensitization, warfarin plus aspirin, cilostazol, ticagrelor, and ticlopidine. However, these options are limited by efficacy and/or toxicity. With its approval in 2009, prasugrel has become a potential treatment option.
Prasugrel may be considered a therapeutic alternative in some patients allergic or intolerant to clopidogrel, but additional data are warranted to make a strong conclusion.
报告 1 例经皮冠状动脉介入治疗（PCI）置入裸金属支架后成功应用普拉格雷的病例，该患者曾对氯吡格雷发生过明确的过敏反应。
患者为 61 岁男性，有冠状动脉疾病和冠状动脉支架置入病史，因 ST 段抬高型心肌梗死就诊。6 年前，该患者在服用氯吡格雷后出现 Stevens-Johnson 综合征，表现为红斑性斑块，随后手脚脱皮；停用氯吡格雷后，他开始接受噻氯匹定加阿司匹林治疗。在置入裸金属支架后，将第三代噻吩吡啶类药物普拉格雷作为氯吡格雷的替代治疗药物，在拔管后给予 60mg 负荷剂量，随后每日给予 10mg。在用药后的数天、数周和数月内，未观察到过敏反应的迹象。
噻吩吡啶类药物，特别是氯吡格雷，是预防冠状动脉支架血栓形成的标准治疗方法；然而，关于这些药物之间交叉过敏反应的数据很少。一项研究表明，27%对氯吡格雷发生过敏或血液学反应的患者对噻氯匹定也会发生类似反应。对氯吡格雷过敏且正在接受 PCI 置入支架的患者的其他治疗选择包括氯吡格雷脱敏、华法林加阿司匹林、西洛他唑、替格瑞洛和噻氯匹定。然而，这些选择受到疗效和/或毒性的限制。普拉格雷于 2009 年获得批准，已成为一种潜在的治疗选择。
对于对氯吡格雷过敏或不耐受的某些患者，普拉格雷可能被视为一种治疗选择，但需要更多的数据来得出明确的结论。
