Seecheran Naveen, Seebalack Victoria, Seecheran Rajeev, Maharaj Aarti, Boodhai Brent, Seecheran Valmiki, Persad Sangeeta, Motilal Shastri, Tello-Montoliu Antonio, Schneider David
Department of Clinical Medical Sciences, The University of the West Indies, St. Augustine, Trinidad and Tobago.
Department of Medicine, North Central Regional Health Authority, Port of Spain, Trinidad and Tobago.
Cardiol Ther. 2019 Jul 10;8(2):229-237. doi: 10.1007/s40119-019-0139-0.
This prospective study aimed to determine whether trimetazidine (TMZ) alters the pharmacodynamic (PD) effects of clopidogrel.
Patients with stable coronary artery disease (SCAD) (n = 24) who were actively treated with dual antiplatelet therapy (DAPT) of aspirin 81 mg daily and clopidogrel 75 mg daily were recruited. Platelet function was measured with the VerifyNow P2Y12 assay (Accriva Diagnostics, San Diego, CA, USA) and assessed before the initiation of and after 14 days of treatment with TMZ. Results were compared using a paired t test.
Almost 80% of the study population were of South Asian descent and had diabetes mellitus (DM). P2Y12 reaction units (PRUs) were higher in patients on TMZ (204 ± 56 compared with 174 ± 71 before TMZ, p = 0.005). The average increase in PRU score was 29 (95% confidence interval 8.8-49.7). Before TMZ, the proportion of patients with high on-treatment platelet reactivity (PRU > 208 units) was 25%, which increased to 42% for patients on TMZ.
Higher platelet reactivity was seen in patients on TMZ, suggesting that TMZ attenuated the PD effects of clopidogrel in this study of a predominantly South Asian diabetic subpopulation. Alternative therapies should be considered and further research is warranted.
ClinicalTrials.gov number, NCT03603249.
这项前瞻性研究旨在确定曲美他嗪（TMZ）是否会改变氯吡格雷的药效学（PD）效应。
招募了24例接受每日81毫克阿司匹林和每日75毫克氯吡格雷双重抗血小板治疗（DAPT）的稳定型冠状动脉疾病（SCAD）患者。使用VerifyNow P2Y12分析（美国加利福尼亚州圣地亚哥的Accriva Diagnostics公司）测量血小板功能，并在开始使用TMZ治疗前和治疗14天后进行评估。使用配对t检验比较结果。
近80%的研究人群为南亚裔且患有糖尿病（DM）。使用TMZ的患者的P2Y12反应单位（PRUs）更高（使用TMZ前为174±71，使用TMZ后为204±56，p = 0.005）。PRU评分的平均增加为29（95%置信区间8.8 - 49.7）。在使用TMZ之前，治疗时血小板高反应性（PRU > 208单位）患者的比例为25%，使用TMZ的患者这一比例增加到42%。
在使用TMZ的患者中观察到更高的血小板反应性，这表明在这项主要针对南亚糖尿病亚人群的研究中，TMZ减弱了氯吡格雷的PD效应。应考虑替代疗法，并且有必要进行进一步研究。
ClinicalTrials.gov编号，NCT03603249。
