Perl Leor, Zemer-Wassercug Noa, Rechavia Eldad, Vaduganathan Muthiah, Orvin Katia, Weissler-Snir Adaya, Lerman-Shivek Hila, Kornowski Ran, Lev Eli I
Department of Cardiology, Rabin Medical Center, Jabotinski st. 39, 49100, Petah Tiqwa, Israel.
J Thromb Thrombolysis. 2015 Jan;39(1):1-7. doi: 10.1007/s11239-014-1119-9.
High on-treatment platelet reactivity (HTPR) despite use of P2Y12 antagonists is associated with adverse cardiac events. The long-term variability in response to prasugrel and ticagrelor is unclear. Our aim was to assess residual platelet reactivity (PR) and rates of HTPR during treatment with prasugrel versus ticagrelor in patients with myocardial infarction (MI). 114 patients with MI treated with percutaneous coronary intervention (PCI) were included. Sixty-two patients were treated with prasugrel (mean age 58 ± 8 years, 21 % women, 29 % diabetes), and 52 patients with ticagrelor (mean age 63 ± 9, 19 % women, 37 % diabetes). Patients were tested for PR at 2-4 days and 30 days post-PCI, using the VerifyNow P2Y12 assay and the multiple-electrode aggregometry. Our results show a higher residual PR in patients treated with prasugrel than those treated with ticagrelor (VerifyNow: 65.4 ± 60.6 vs. 26.0 ± 24.2 P2Y12 reaction units, p < 0.001 at 2-4 days, and 67.3 ± 62.5 vs. 21.1 ± 26.1, p < 0.001 at follow-up). HTPR rates were higher in the prasugrel group (8.1-11.3 % vs. none with ticagrelor in the early test, and 8.7-10.9 % vs. none with ticagrelor at follow-up). In conclusion, in patients with MI undergoing PCI, treatment with ticagrelor resulted in greater platelet inhibition and lower HTPR rates compared with prasugrel, up to 30 days after the event.
尽管使用了P2Y12拮抗剂，但高治疗期血小板反应性（HTPR）仍与不良心脏事件相关。对普拉格雷和替格瑞洛反应的长期变异性尚不清楚。我们的目的是评估心肌梗死（MI）患者在接受普拉格雷与替格瑞洛治疗期间的残余血小板反应性（PR）和HTPR发生率。纳入了114例行经皮冠状动脉介入治疗（PCI）的MI患者。62例患者接受普拉格雷治疗（平均年龄58±8岁，21%为女性，29%患有糖尿病），52例患者接受替格瑞洛治疗（平均年龄63±9岁，19%为女性，37%患有糖尿病）。在PCI术后2 - 4天和30天，使用VerifyNow P2Y12分析和多电极聚集测定法对患者进行PR检测。我们的结果显示，接受普拉格雷治疗的患者残余PR高于接受替格瑞洛治疗的患者（VerifyNow：2 - 4天时为65.4±60.6 vs. 26.0±24.2 P2Y12反应单位，p<0.001；随访时为67.3±62.5 vs. 21.1±26.1，p<0.001）。普拉格雷组的HTPR发生率更高（早期检测时为8.1 - 11.3% vs.替格瑞洛组无，随访时为8.7 - 10.9% vs.替格瑞洛组无）。总之，在接受PCI的MI患者中，与普拉格雷相比，替格瑞洛治疗在事件发生后长达30天内可导致更强的血小板抑制作用和更低的HTPR发生率。
