Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria.
Cardiovasc Ther. 2013 Oct;31(5):e40-5. doi: 10.1111/1755-5922.12021.
The antiplatelet effects of clopidogrel and prasugrel have mainly been compared using different platelet reactivity tests. Further, data on the impact of both drugs on thrombin-inducible platelet activation are scarce. We therefore investigated the influence of clopidogrel and prasugrel on different flow cytometric parameters of platelet activation as well as on platelet function assessed by leukocyte-platelet interaction.
Baseline, ADP and thrombin receptor-activating peptide (TRAP)-6 inducible P-selectin expression, activation of glycoprotein (GP) IIb/IIIa and monocyte-platelet aggregate (MPA) formation were determined by flow cytometry in 84 clopidogrel- and 21 prasugrel-treated patients undergoing percutaneous coronary intervention with stent implantation.
Baseline expressions of P-selectin and activated GPIIb/IIIa did not differ significantly between clopidogrel- and prasugrel-treated patients (both P > 0.2). After activation with ADP or TRAP-6, patients with clopidogrel therapy exhibited significantly higher platelet surface expressions of P-selectin and activated GPIIb/IIIa than prasugrel-treated patients (all P ≤ 0.001). Further, high P-selectin and high GPIIb/IIIa were significantly more frequent in clopidogrel-treated patients than in patients on prasugrel therapy (all P = 0.01). Likewise, the formation of MPA without addition of agonists did not differ significantly between patients receiving clopidogrel and patients on prasugrel therapy (P = 0.2). After activation with ADP or TRAP-6, clopidogrel-treated patients showed a significantly more pronounced formation of MPA than patients-receiving prasugrel (both P = 0.02).
Prasugrel reduces ADP and TRAP-6 inducible platelet activation, and leukocyte-platelet interaction more efficiently than clopidogrel.
氯吡格雷和普拉格雷的抗血小板作用主要通过不同的血小板反应性试验进行比较。此外，关于这两种药物对凝血酶诱导的血小板激活影响的数据也很少。因此，我们研究了氯吡格雷和普拉格雷对血小板激活的不同流式细胞术参数以及白细胞-血小板相互作用评估的血小板功能的影响。
在 84 例接受经皮冠状动脉介入治疗（支架植入术）的氯吡格雷和 21 例普拉格雷治疗的患者中，通过流式细胞术测定基础状态、ADP 和血栓素受体激活肽（TRAP）-6 诱导的 P-选择素表达、糖蛋白（GP）IIb/IIIa 激活和单核细胞-血小板聚集体（MPA）形成。
氯吡格雷和普拉格雷治疗的患者之间基础状态下 P-选择素和激活的 GPIIb/IIIa 的表达无显著差异（均 P > 0.2）。在用 ADP 或 TRAP-6 激活后，氯吡格雷治疗的患者血小板表面 P-选择素和激活的 GPIIb/IIIa 的表达明显高于普拉格雷治疗的患者（均 P ≤ 0.001）。此外，高 P-选择素和高 GPIIb/IIIa 在氯吡格雷治疗的患者中比在接受普拉格雷治疗的患者中更为常见（均 P = 0.01）。同样，在不加入激动剂的情况下，接受氯吡格雷治疗的患者与接受普拉格雷治疗的患者之间的 MPA 形成无显著差异（P = 0.2）。在用 ADP 或 TRAP-6 激活后，氯吡格雷治疗的患者形成的 MPA 明显比接受普拉格雷治疗的患者更为明显（均 P = 0.02）。
普拉格雷比氯吡格雷更有效地减少 ADP 和 TRAP-6 诱导的血小板激活和白细胞-血小板相互作用。
