Département de Cardiologie, Hôpital Universitaire Nord, Faculté De Médecine, Université de la Méditerranée, Marseille, France.
Am J Cardiol. 2011 Dec 15;108(12):1710-3. doi: 10.1016/j.amjcard.2011.07.038. Epub 2011 Sep 8.
Antiplatelet agents are critical to prevent thrombotic events in patients with acute coronary syndromes, particularly those who undergo percutaneous coronary intervention. Prasugrel is a potent P2Y(12)-adenosine diphosphate receptor antagonist that is superior to clopidogrel in such patients. Previous studies have observed that nuisance and internal bleedings were relatively frequent in patients under clopidogrel therapy and were associated with noncompliance. Furthermore, premature drug discontinuation is associated with thrombotic recurrences. The aim of the present study was to investigate the rate of nuisance or internal bleedings in patients receiving prasugrel and its relation with compliance. This prospective multicenter study included 396 patients. Bleeding events were recorded and classified as alarming, nuisance, or internal according. Compliance with prasugrel therapy was assessed. Almost half of the patients (48.5%) were included for ST-segment elevation acute coronary syndromes. During the 1-month follow-up period, 54 patients (13.6%) had bleeding events. Most bleeding events were classified as internal or nuisance (96%). Internal and nuisance bleedings were associated with high rates of prasugrel discontinuation (16.6% and 14.7%, respectively). Nuisance and internal bleedings were significantly associated with prasugrel discontinuation in multivariate analysis (odds ratio 3.1, 95% confidence interval 1.01 to 9.2, p = 0.04). The rate of major adverse cardiovascular events was 2.3%. No relation was observed between minor bleeds, compliance, and major adverse cardiovascular events. In conclusion, in the present study, minor bleedings were common during the first month after percutaneous coronary intervention and were significantly associated with prasugrel withdrawal.
抗血小板药物对于预防急性冠脉综合征患者的血栓事件至关重要，尤其是那些接受经皮冠状动脉介入治疗的患者。普拉格雷是一种强效的 P2Y(12)-腺苷二磷酸受体拮抗剂，在这些患者中优于氯吡格雷。先前的研究观察到，接受氯吡格雷治疗的患者经常出现不适和内部出血，这与不遵医嘱有关。此外，过早停药与血栓复发有关。本研究旨在调查接受普拉格雷治疗的患者不适或内部出血的发生率及其与依从性的关系。这项前瞻性多中心研究纳入了 396 名患者。记录出血事件并根据情况进行分类，包括警报、不适或内部。评估了患者对普拉格雷治疗的依从性。近一半的患者（48.5%）患有 ST 段抬高型急性冠脉综合征。在 1 个月的随访期间，54 名患者（13.6%）发生了出血事件。大多数出血事件被归类为内部或不适（96%）。内部和不适出血与普拉格雷停药率高相关（分别为 16.6%和 14.7%）。多变量分析显示，不适和内部出血与普拉格雷停药显著相关（比值比 3.1，95%置信区间 1.01 至 9.2，p = 0.04）。主要不良心血管事件的发生率为 2.3%。在次要出血、依从性和主要不良心血管事件之间未观察到相关性。总之，在本研究中，经皮冠状动脉介入治疗后第一个月内常见轻微出血，且与普拉格雷停药显著相关。
