Sandhu Amneet, Seth Milan, Dixon Simon, Share David, Wohns David, Lalonde Thomas, Moscucci Mauro, Riba Arthur L, Grossman Michael, Gurm Hitinder S
Department of Internal Medicine, Division of Cardiovascular Medicine, The University of Michigan, Ann Arbor, MI 48109, USA.
Circ Cardiovasc Qual Outcomes. 2013 May 1;6(3):293-8. doi: 10.1161/CIRCOUTCOMES.111.000060. Epub 2013 May 14.
Prasugrel is a recently approved thienopyridine for use in patients with acute coronary syndromes undergoing percutaneous coronary intervention. There are no data on contemporary use of prasugrel in routine clinical practice.
We assessed the patterns of prasugrel use among 55 821 patients who underwent percutaneous coronary intervention and were discharged alive from January 2010 to December 2011 at 44 hospitals participating in the Blue Cross Blue Shield of Michigan Cardiovascular Consortium. Potential inappropriate therapy was defined as use in patients who had a history of cerebrovascular disease, weighed <60 kg, or were aged ≥75 years old. Clopidogrel was prescribed to 83% (n=46 574) and 17% (n=9247) of patients received prasugrel on hospital discharge. A steady, linear increase in prasugrel use was seen during the study period, with discharge prescription increasing from 8.4% in quarter 1 of 2010 to 22.3% in quarter 4 of 2011. Of the total cohort, 69.1% of patients presented with acute coronary syndrome, and in this group, 17.2% received prasugrel. Among patients prescribed prasugrel, 28.3% (n=2614) received the medication for indications outside of acute coronary syndromes. One or more known contraindications to the drug were present in 6% to 10% of patients discharged on this agent.
There has been a steady increase in the use of prasugrel with the drug being used in ≈22% of patients undergoing percutaneous coronary intervention by study end. Prasugrel use in patients with known contraindications is not uncommon and may be a suitable target for focused quality improvement efforts.
普拉格雷是一种最近被批准用于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噻吩并吡啶类药物。目前尚无关于普拉格雷在常规临床实践中当代使用情况的数据。
我们评估了2010年1月至2011年12月期间在密歇根蓝十字蓝盾心血管联盟的44家医院接受经皮冠状动脉介入治疗并存活出院的55821例患者中普拉格雷的使用模式。潜在不适当治疗被定义为在有脑血管疾病史、体重<60公斤或年龄≥75岁的患者中使用。83%（n = 46574）的患者使用氯吡格雷，17%（n = 9247）的患者在出院时接受普拉格雷治疗。在研究期间，普拉格雷的使用呈稳定的线性增加，出院处方从2010年第一季度的8.4%增加到2011年第四季度的22.3%。在整个队列中，69.1%的患者表现为急性冠状动脉综合征，在该组中，17.2%的患者接受普拉格雷治疗。在接受普拉格雷治疗的患者中，28.3%（n = 2614）因急性冠状动脉综合征以外的适应症接受该药物治疗。在使用该药物出院的患者中，6%至10%的患者存在一种或多种已知的药物禁忌症。
普拉格雷的使用一直在稳步增加，到研究结束时，约22%接受经皮冠状动脉介入治疗的患者使用了该药物。在已知有禁忌症的患者中使用普拉格雷并不罕见，可能是集中质量改进努力的合适目标。
