Alexopoulos D, Stavrou K, Koniari I, Gkizas V, Perperis A, Kontoprias K, Vogiatzi C, Bampouri T, Xanthopoulou I
Dimitrios Alexopoulos, MD, FACC, FESC, Cardiology Department, Patras University Hospital, Rion 26500, Patras, Greece, Tel/Fax: +30 2610992941, E-mail:
Thromb Haemost. 2014 Sep 2;112(3):551-7. doi: 10.1160/TH14-02-0119. Epub 2014 Jul 3.
Platelet reactivity (PR) and bleeding events following therapy with ticagrelor vs prasugrel have not been adequately studied. We aimed to compare PR and bleeding events in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) while on ticagrelor vs prasugrel for one month. Consecutive patients who were discharged either on ticagrelor 90 mg bid maintenance dose (MD) or prasugrel 10 mg MD were invited for PR assessment (VerifyNow, in PRU) at one month. High PR (HPR) was defined as >208 PRU. Bleeding events [Bleeding Academic Research Consortium (BARC) classification] were monitored. Out of 937 screened patients, 512 were analysed, 278 under ticagrelor MD and 234 under prasugrel MD. PR at 30 days (C-statistic of the propensity score model 0.63, 0.58-0.67 95% CI, p<0.001) was lower when on ticagrelor compared with prasugrel (33.3, 95% CI 29.3-37.3 vs 84.6, 95% CI 73.6-95.6, p<0.001). In the analysed population more BARC type 1 bleeding events were observed with ticagrelor compared to prasugrel (36.7% vs 28.2%, p=0.047). In 221 propensity score matched pairs, BARC type 1 bleeding rate was marginally higher in ticagrelor vs prasugrel treated patients (35.7% vs 27.1%, p=0.05). BARC type ≥2 events did not differ between groups 5 (2.3%) vs 5 (2.3%). HPR rate was higher for prasugrel-treated patients (5.4% vs 0%, p<0.001). In conclusion, in patients with ACS undergoing PCI, ticagrelor MD produces a significantly higher platelet inhibition compared to prasugrel MD. This pharmacodynamic difference might be associated with more nuisance bleeding events with ticagrelor use.
替格瑞洛与普拉格雷治疗后的血小板反应性（PR）及出血事件尚未得到充分研究。我们旨在比较接受经皮冠状动脉介入治疗（PCI）的急性冠状动脉综合征（ACS）患者在服用替格瑞洛与普拉格雷1个月时的PR及出血事件。连续入选的出院患者，若服用替格瑞洛90 mg每日两次维持剂量（MD）或普拉格雷10 mg MD，则在1个月时接受PR评估（VerifyNow，以PRU为单位）。高PR（HPR）定义为>208 PRU。监测出血事件[采用出血学术研究联盟（BARC）分类]。在937例筛查患者中，512例进行了分析，其中278例服用替格瑞洛MD，234例服用普拉格雷MD。与普拉格雷相比，服用替格瑞洛时30天的PR（倾向评分模型的C统计量为0.63，95%CI为0.58 - 0.67，p<0.001）更低（33.3，95%CI为29.3 - 37.3 vs 84.6，95%CI为73.6 - 95.6，p<0.001）。在分析的人群中，与普拉格雷相比，替格瑞洛组观察到更多的BARC 1型出血事件（36.7% vs 28.2%，p = 0.047）。在221对倾向评分匹配的患者中，替格瑞洛治疗组的BARC 1型出血率略高于普拉格雷治疗组（35.7% vs 27.1%，p = 0.05）。两组间BARC≥2型事件无差异（5例[2.3%] vs 5例[2.3%]）。普拉格雷治疗患者的HPR率更高（5.4% vs 0%，p<0.001）。总之，在接受PCI的ACS患者中，替格瑞洛MD产生的血小板抑制作用显著高于普拉格雷MD。这种药效学差异可能与替格瑞洛使用时更多的烦扰性出血事件有关。
