Division of Cardiology, Onassis Cardiac Surgery Center, Athens, Greece.
Eur Rev Med Pharmacol Sci. 2017 Oct;21(20):4733-4743.
Dual antiplatelet therapy (DAPT) is the treatment of choice in the medical management of patients with acute coronary syndrome (ACS). The combination of aspirin and a P2Y12 inhibitor in patients who receive a coronary stent reduces the rate of stent thrombosis and the rates of major adverse cardiovascular events. However, patients with acute coronary syndrome remain at risk of recurrent cardiovascular events despite the advance of medical therapy. The limitations of clopidogrel with variable antiplatelet effects and delayed onset of action are well established and lead to the development of newer P2Y12 inhibitors. Prasugrel is a selective adenosine diphosphate (ADP) receptor antagonist indicated for use in patients with ACS. Prasugrel provides greater inhibition of platelet aggregation than clopidogrel and has a rapid onset of action. We have conducted a systematic review to retrieve current evidence regarding the role of prasugrel in the management of ACS. Evidence comparing prasugrel, clopidogrel, and ticagrelor remain scant.
A complete literature survey was performed using PubMed database search to gather available information regarding management of acute coronary syndromes and prasugrel. An explorative comparison of the safety and efficacy of prasugrel, clopidogrel, and ticagrelor was also conducted.
Prasugrel and ticagrelor are more efficacious than clopidogrel in reducing the occurrence of non-fatal myocardial infarction, stroke, or cardiovascular (CV) death but they have also an increased risk of major bleeding in comparison to clopidogrel.
Prasugrel and ticagrelor are today the recommended first-line agents in patients with ACS. The estimation of which drug is superior over the other cannot be reliably established from the current trials.
双联抗血小板治疗（DAPT）是急性冠状动脉综合征（ACS）患者医学治疗的首选方案。在接受冠状动脉支架置入术的患者中，阿司匹林和 P2Y12 抑制剂的联合使用可降低支架血栓形成的发生率和主要心血管不良事件的发生率。然而，尽管采用了先进的药物治疗，急性冠状动脉综合征患者仍有发生心血管事件复发的风险。氯吡格雷抗血小板作用可变和作用起效延迟的局限性已得到充分证实，这导致了新型 P2Y12 抑制剂的发展。普拉格雷是一种用于治疗 ACS 的选择性二磷酸腺苷（ADP）受体拮抗剂。普拉格雷可更有效地抑制血小板聚集，且起效迅速。我们进行了一项系统评价，以检索关于普拉格雷在 ACS 治疗中的作用的现有证据。比较普拉格雷、氯吡格雷和替格瑞洛的证据仍然很少。
使用 PubMed 数据库检索进行了全面的文献调查，以收集有关急性冠状动脉综合征和普拉格雷管理的可用信息。还对普拉格雷、氯吡格雷和替格瑞洛的安全性和疗效进行了探索性比较。
普拉格雷和替格瑞洛在降低非致命性心肌梗死、中风或心血管（CV）死亡的发生方面比氯吡格雷更有效，但与氯吡格雷相比，它们也有更高的大出血风险。
普拉格雷和替格瑞洛是目前 ACS 患者的首选一线药物。从目前的试验中无法可靠地确定哪种药物优于另一种药物。
