Guimarães Leonardo de F C, Généreux Philippe, Silveira Diego, Pesaro Antonio Eduardo, Falcão Felipe, Barbosa Bruno Robalinho C, de Souza Cristiano Freitas, Fonseca Francisco A H, Alves Cláudia Maria Rodrigues, Carvalho Antônio Carlos de Camargo, Stone Gregg W, Caixeta Adriano
Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil.
Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, United States; New York-Presbyterian Hospital/Columbia University Medical Center, New York, New York, United States; Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Quebec, Canada; Morristown Medical Center, Morristown, New Jersey, United States.
Int J Cardiol. 2017 Mar 1;230:204-208. doi: 10.1016/j.ijcard.2016.12.173. Epub 2016 Dec 27.
A pharmacodynamic comparison between ticagrelor and prasugrel after fibrinolytic therapy has not yet been performed.
In the single-center SAMPA trial, 50 consecutive STEMI patients previously treated with clopidogrel and undergoing a pharmacoinvasive strategy were randomized to either a ticagrelor (n=25) 180mg loading dose followed by 90mg bid, or a prasugrel (n=25) 60mg loading dose followed by 10mg/day, initiated after fibrinolytic therapy but before angiography. Platelet reactivity was assessed with the VerifyNow P2Y assay at 0, 2, 6, and 24h after randomization.
Mean times from fibrinolysis to prasugrel or ticagrelor administration were 11.1±6.9 and 13.3±6.3h, respectively (p=0.24). The values of PRU decreased significantly from baseline to 2h (all p<0.001) and from 2h to 6h (all p<0.001) in both groups. There was no difference in PRU values between 6h and 24h. The mean PRU values at 0, 2, 6, and 24h were 234.9, 127.8, 45.4, and 48.0 in the prasugrel group and 233.1, 135.1, 67.7, and 56.9 in the ticagrelor group, respectively. PRU values did not significantly differ between groups at any time period of the study.
In patients with STEMI treated with fibrinolytic therapy, platelet inhibition after clopidogrel is suboptimal and can be further increased with more potent agents. Ticagrelor and prasugrel demonstrated a similar extent of P2Y receptor inhibition within 24h, although maximal platelet inhibition after these potent agents was not achieved for 6h.
尚未对纤溶治疗后替格瑞洛和普拉格雷进行药效学比较。
在单中心SAMPA试验中，50例先前接受氯吡格雷治疗且采用药物侵入性策略的连续ST段抬高型心肌梗死（STEMI）患者被随机分为两组，一组给予替格瑞洛（n = 25）180mg负荷剂量，随后90mg每日两次；另一组给予普拉格雷（n = 25）60mg负荷剂量，随后10mg/天，在纤溶治疗后但在血管造影术前开始用药。在随机分组后0、2、6和24小时，使用VerifyNow P2Y检测法评估血小板反应性。
从纤溶到给予普拉格雷或替格瑞洛的平均时间分别为11.1±6.9小时和13.3±6.3小时（p = 0.24）。两组患者从基线到2小时（所有p<0.001）以及从2小时到6小时（所有p<0.001），血小板反应单位（PRU）值均显著下降。6小时和24小时的PRU值无差异。普拉格雷组在0、2、6和24小时的平均PRU值分别为234.9、127.8、45.4和48.0，替格瑞洛组分别为233.1、135.1、67.7和56.9。在研究的任何时间段，两组间PRU值均无显著差异。
在接受纤溶治疗的STEMI患者中，氯吡格雷后的血小板抑制效果欠佳，使用更强效药物可进一步增强抑制作用。替格瑞洛和普拉格雷在24小时内表现出相似程度的P2Y受体抑制，尽管这些强效药物在6小时后才达到最大血小板抑制效果。
