Fiore Mathieu, Horovitz Alice, Pons Anne-Cecile, Leroux Lionel, Casassus Frederic
Laboratoire d'Hématologie, Hôpital Cardiologique du Haut-Lévêque , CHU de Bordeaux, Pessac , France .
Platelets. 2014;25(8):636-8. doi: 10.3109/09537104.2013.852659. Epub 2013 Nov 18.
Prasugrel is a widely used antiplatelet agent in the setting of percutaneous coronary intervention. In case of resistance to this third-generation thienopyridine, choices of alternative drugs remain limited. Here, we describe a case of a 49-year-old man with stent thrombosis occurring 5 days after drug-eluting stent implantation despite a well-conducted antiplatelet therapy with aspirin and prasugrel. Evaluation of platelet functions by different tests revealed prasugrel resistance. Genotyping for various CYP single-nucleotide polymorphisms showed that the patient carried mutant alleles encoding enzymes CYP2B6 and CYP2C9 involved in prasugrel metabolic pathway. Strikingly, an adequate platelet response was rapidly obtained after switching from prasugrel to ticagrelor.
普拉格雷是经皮冠状动脉介入治疗中广泛使用的抗血小板药物。在对这种第三代噻吩并吡啶产生耐药的情况下，替代药物的选择仍然有限。在此，我们描述了一例49岁男性患者，尽管使用阿司匹林和普拉格雷进行了规范的抗血小板治疗，但在药物洗脱支架植入术后5天仍发生了支架内血栓形成。通过不同检测方法对血小板功能进行评估显示存在普拉格雷抵抗。对各种CYP单核苷酸多态性进行基因分型表明，该患者携带参与普拉格雷代谢途径的编码CYP2B6和CYP2C9酶的突变等位基因。令人惊讶的是，从普拉格雷换用替格瑞洛后迅速获得了充分的血小板反应。
