Cahoon William D, Kroll Amanda L, Lowe Denise K
Virginia Commonwealth University Health Systems, Richmond, VA, USA.
J Pharm Technol. 2015 Feb;31(1):38-42. doi: 10.1177/8755122514545776. Epub 2014 Aug 8.
: To report a case of high on-treatment platelet reactivity (HTPR) with prasugrel maintenance therapy despite adequate initial platelet response to a loading dose. : A 51-year-old woman presented to the emergency department complaining of chest pain. She was diagnosed with acute-on-chronic systolic heart failure and non-ST-elevated myocardial infarction (MI). She had a previous MI with bare metal stent placement and was taking aspirin and prasugrel 10 mg daily. Once admitted, a P2Y assay revealed HTPR (331 PRU); therefore, prasugrel was reloaded (60 mg). The next day a P2Y assay showed adequate platelet reactivity inhibition (118 PRU), so prasugrel 10 mg daily was continued in the hospital and on discharge. Seventeen days after discharge she was readmitted for possible ischemia. On day 3 of admission, a P2Y assay revealed HTPR (278 PRU); subsequently, prasugrel was discontinued and ticagrelor started. After 3 doses of ticagrelor, a P2Y assay was 97 PRU, so ticagrelor was continued. Five months have passed since discharge. The patient continues to take ticagrelor and has had no further cardiac events. : HTPR indicates hypo- or nonresponsiveness for antiplatelet agents and may result in serious adverse events. HTPR has rarely been reported with prasugrel or ticagrelor. An objective causality assessment of our case revealed a probable association between HTPR and prasugrel. : Patient education and recognition of signs and symptoms associated with prasugrel HTPR may prevent morbidity and mortality from treatment failure. Additional research may determine incidence, risk factors, and optimal management of HTPR with prasugrel.
报告一例尽管负荷剂量后初始血小板反应充分，但在普拉格雷维持治疗期间出现高治疗期血小板反应性（HTPR）的病例。一名51岁女性因胸痛就诊于急诊科。她被诊断为慢性收缩性心力衰竭急性发作和非ST段抬高型心肌梗死（MI）。她既往有心肌梗死病史并植入了裸金属支架，目前每日服用阿司匹林和10毫克普拉格雷。入院后，血小板功能检测显示HTPR（331 PRU）；因此，再次给予普拉格雷负荷剂量（60毫克）。第二天血小板功能检测显示血小板反应性得到充分抑制（118 PRU），所以患者在住院期间及出院后继续每日服用10毫克普拉格雷。出院17天后，她因可能的缺血再次入院。入院第3天，血小板功能检测显示HTPR（278 PRU）；随后，停用普拉格雷并开始使用替格瑞洛。给予3剂替格瑞洛后，血小板功能检测结果为97 PRU，所以继续使用替格瑞洛。出院后已过去5个月。患者继续服用替格瑞洛，未再发生心脏事件。HTPR提示抗血小板药物反应低下或无反应，可能导致严重不良事件。普拉格雷或替格瑞洛很少报告出现HTPR。对本病例进行的客观因果关系评估显示，HTPR与普拉格雷之间可能存在关联。对患者进行教育并认识与普拉格雷HTPR相关的体征和症状，可能预防治疗失败导致的发病和死亡。进一步的研究可能确定HTPR在普拉格雷治疗中的发生率、危险因素及最佳管理方法。
