Yin Ellen B, Nguyen Huy, Kamat Ishan, Bayat Maryam, Alam Mahboob
P T. 2018 Nov;43(11):667-674.
To assess the contemporary use of adenosine diphosphate (ADP) receptor inhibitors in acute coronary syndrome at a large, quaternary academic medical center.
A retrospective observational study was conducted using health records to compare patients who were treated with ticagrelor (Brilinta, AstraZeneca), prasugrel, or clopidogrel for a primary diagnosis of new-onset acute coronary syndrome between January 2014 and December 2014.
A total of 275 patients were identified. Clopidogrel was the most commonly prescribed ADP receptor antagonist (52%), followed by ticagrelor (26%) and prasugrel (22%). Patients who were prescribed clopidogrel were more likely female ( < 0.01), 75 years of age or older ( < 0.01), and 60 kg or less in weight ( = 0.02), and they had more comorbidities. Of the patients on clopidogrel prior to admission, 21% were switched to prasugrel or ticagrelor for inadequate platelet inhibition, restenosis, or new stent placement. Of the patients on ticagrelor or prasugrel prior to admission, 17% were switched to clopidogrel for concerns about bleeding or cost. Clopidogrel was prescribed 13% of the time, prasugrel 13% of the time, and ticagrelor 4% of the time ( = 0.13) outside the recommended use per Food and Drug Administration-approved prescribing information based on relative or absolute contraindications.
Clopidogrel continues to be the most commonly prescribed antiplatelet agent, particularly in older patients with more comorbidities.
在一家大型四级学术医疗中心评估当代急性冠状动脉综合征中腺苷二磷酸（ADP）受体抑制剂的使用情况。
进行一项回顾性观察研究，利用健康记录比较2014年1月至2014年12月期间因新发急性冠状动脉综合征的初步诊断而接受替格瑞洛（倍林达，阿斯利康）、普拉格雷或氯吡格雷治疗的患者。
共识别出275例患者。氯吡格雷是最常处方的ADP受体拮抗剂（52%），其次是替格瑞洛（26%）和普拉格雷（22%）。处方氯吡格雷的患者更可能为女性（P<0.01）、75岁及以上（P<0.01）、体重60千克及以下（P = 0.02），且合并症更多。入院前服用氯吡格雷的患者中，21%因血小板抑制不足、再狭窄或新支架置入而换用普拉格雷或替格瑞洛。入院前服用替格瑞洛或普拉格雷的患者中，17%因出血或费用问题而换用氯吡格雷。根据美国食品药品监督管理局批准的处方信息，基于相对或绝对禁忌证，氯吡格雷在推荐使用范围外的处方时间为13%，普拉格雷为13%，替格瑞洛为4%（P = 0.13）。
氯吡格雷仍然是最常处方的抗血小板药物，尤其是在合并症更多的老年患者中。
