Furuse Erito, Takano Hitoshi, Yamamoto Takeshi, Kubota Yoshiaki, Yoshizane Takashi, Kitamura Mitsunobu, Miyachi Hideki, Hosokawa Yusuke, Shimizu Wataru
Division of Intensive Cardiovascular Care, Nippon Medical School, Tokyo, Japan.
Department of Cardiovascular Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan.
Heart Vessels. 2017 Dec;32(12):1432-1438. doi: 10.1007/s00380-017-1016-1. Epub 2017 Jul 6.
Prasugrel is often replaced with clopidogrel after a certain period of time following coronary stenting. However, the time course of platelet aggregation during this replacement is unknown. We performed a prospective, single-arm study to monitor platelet reactivity before and after the replacement. Forty-five patients (mean age 62.6 ± 13 years, 40 male) who received coronary stenting for acute coronary syndrome were initially treated with the loading dose (20 mg) of prasugrel followed by the maintenance dose (3.75 mg/day) for 7 days, then switched to 75 mg/day of clopidogrel. The P2Y12 reaction unit (PRU) level was measured at baseline and selected time points. Prasugrel effectively suppressed PRU from 248 ± 59 at baseline to 145 ± 65 on day 1 (P < 0.001). The PRU value on the final day of prasugrel treatment (day 7) was 156 ± 68 (P < 0.001 vs. baseline). After switching to clopidogrel, PRU was consistently suppressed [146 ± 60, 139 ± 54, and 135 ± 60 on days 9, 11, and 13, respectively (P < 0.001, each point vs. baseline)]. Switching from the initial prasugrel therapy to clopidogrel using the maintenance dose does not cause a drug efficacy gap and stays effective for preventing stent thrombosis.
在冠状动脉支架置入术后一段时间，普拉格雷常被氯吡格雷替代。然而，这种替代过程中血小板聚集的时间进程尚不清楚。我们进行了一项前瞻性单臂研究，以监测替代前后的血小板反应性。45例（平均年龄62.6±13岁，40例男性）因急性冠状动脉综合征接受冠状动脉支架置入术的患者，最初接受普拉格雷负荷剂量（20mg）治疗，随后维持剂量（3.75mg/天）治疗7天，然后换用氯吡格雷75mg/天。在基线和选定时间点测量P2Y12反应单位（PRU）水平。普拉格雷有效地将PRU从基线时的248±59降至第1天的145±65（P<0.001）。普拉格雷治疗最后一天（第7天）的PRU值为156±68（与基线相比，P<0.001）。换用氯吡格雷后，PRU持续受到抑制[第9、11和13天分别为146±60、139±54和135±60（各时间点与基线相比，P<0.001）]。从最初的普拉格雷治疗换用维持剂量的氯吡格雷不会导致药物疗效差距，并且在预防支架血栓形成方面仍保持有效。
