Song Kai, Jin Xuan, Kim Moo-Hyun, Li Jia-Xin, Jin Cai-De, Yuan Song-Lin, Song Zhao-Yan, Jin En-Ze, Lee Kwang-Min, Lim Kyung-Hee, Cho Young-Rak
Department of Cardiology, Dong-A University Hospital, Busan 49201, Korea.
Department of Cardiology, Huizhou Third People's Hospital, Guangzhou Medical University, Huizhou 516002, China.
J Clin Med. 2022 Apr 28;11(9):2480. doi: 10.3390/jcm11092480.
Background: East Asian patients receiving treatment with the potent P2Y12 inhibitors prasugrel or ticagrelor experience more potent platelet inhibition than with clopidogrel. Methods: This study investigated differences in OPR rates with reduced doses of prasugrel (n = 38) or ticagrelor (n = 40) for maintenance therapy in 118 Korean ACS patients who had undergone PCI, in comparison to conventional-dose clopidogrel (n = 40). We assessed drug responses at one- and three-months post-PCI with VerifyNow and multiple electrode aggregometry assays. Results: At the one-month period, patients receiving standard-dose prasugrel or ticagrelor had lower platelet reactivity as determined by the three assays than those receiving the conventional dose of clopidogrel (VN: p = 0.000; MEA: p = 0.000; LTA: p = 0.000). At the 3-month point, platelet reactivity was lower in those receiving reduced-dose prasugrel or ticagrelor than the clopidogrel-treated patients (VN: p = 0.000; MEA: p = 0.012; LTA: p = 0.002). Prasugrel resulted in significantly lower platelet inhibition than ticagrelor as determined by VN and LTA (VN: p = 0.000; LTA: p = 0.003). At three months, there was a significant overall difference in OPR among the three groups when measured by VN (p < 0.001), but not when measured by MEA (p = 0.596). OPR in the reduced-dose prasugrel group was not significantly different to the clopidogrel group at three months (VN: p = 0.180; MEA: p = 0.711). OPR in the reduced-dose ticagrelor group was similar to clopidogrel as determined by MEA at three months, but was different when assessed by VN (VN: p = 0.000; MEA: p = 0.540). Compared to standard-dose, the reduced-dose prasugrel OPR rate was significantly increased (VN: p = 0.008; MEA: p = 0.020). Conclusions: OPR values for reduced-dose prasugrel and conventional-dose clopidogrel at three months were similar but higher than for reduced-dose ticagrelor as determined by VN, but no differences were noted by MEA. The MEA assay might have less sensitivity and consistency than the VN assay. Further studies are needed to explore this discrepancy.
接受强效P2Y12抑制剂普拉格雷或替格瑞洛治疗的东亚患者，其血小板抑制作用比氯吡格雷更强。方法：本研究调查了118例接受过PCI的韩国急性冠脉综合征（ACS）患者，使用低剂量普拉格雷（n = 38）或替格瑞洛（n = 40）进行维持治疗时的优化血小板反应（OPR）率差异，并与常规剂量氯吡格雷（n = 40）进行比较。我们在PCI术后1个月和3个月时，使用VerifyNow和多电极聚集分析法评估药物反应。结果：在1个月时，通过三种检测方法测定，接受标准剂量普拉格雷或替格瑞洛的患者血小板反应性低于接受常规剂量氯吡格雷的患者（VerifyNow：p = 0.000；多电极聚集分析法：p = 0.000；光透比浊法：p = 0.000）。在3个月时，接受低剂量普拉格雷或替格瑞洛的患者血小板反应性低于氯吡格雷治疗的患者（VerifyNow：p = 0.000；多电极聚集分析法：p = 0.012；光透比浊法：p = 0.002）。通过VerifyNow和光透比浊法测定，普拉格雷导致的血小板抑制作用明显低于替格瑞洛（VerifyNow：p = 0.000；光透比浊法：p = 0.
