瑞度格雷（一种血栓素A2合酶抑制剂与血栓素A2/前列腺素内过氧化物受体拮抗剂的组合药物）与阿司匹林作为急性心肌梗死患者溶栓辅助治疗的随机试验。瑞度格雷与阿司匹林通畅性试验（RAPT）。

Randomized trial of ridogrel, a combined thromboxane A2 synthase inhibitor and thromboxane A2/prostaglandin endoperoxide receptor antagonist, versus aspirin as adjunct to thrombolysis in patients with acute myocardial infarction. The Ridogrel Versus Aspirin Patency Trial (RAPT).

出版信息

Circulation. 1994 Feb;89(2):588-95. doi: 10.1161/01.cir.89.2.588.

DOI:10.1161/01.cir.89.2.588

Abstract

BACKGROUND

Aspirin, by nonselectively blocking cyclooxygenase both in platelets and in endothelial cells, not only inhibits the thromboxane A2 pathway of platelet activation but at the same time also the generation of vasodilating and platelet-inhibitory prostanoids, such as prostacyclin, by the endothelial cells. Ridogrel, by inhibiting thromboxane A2 synthase and blocking the thromboxane A2/prostaglandin endoperoxide receptors, is a more potent antiplatelet agent than aspirin and might offer an advantage over aspirin as an adjunct to thrombolysis. This study was performed to compare the efficacy and safety of ridogrel with that of aspirin as conjunctive therapy for thrombolysis in patients with acute myocardial infarction.

METHODS AND RESULTS

A total of 907 patients with acute myocardial infarction were randomized between aspirin and ridogrel given in addition to streptokinase (1.5 MU over a period of 1 hour). The primary end point was coronary patency (TIMI flow grades 2 and 3) at predischarge angiography to be performed between 7 and 14 days after admission. A patent infarct-related vessel was found in similar proportions of patients in the two treatment groups: 72.2% in the ridogrel and 75.5% in the aspirin group. The presence of clinical markers of reperfusion at 2 hours and the incidence of major clinical events during hospital stay were also similar in both groups. However, in a post hoc analysis, a lower incidence of new ischemic events (reinfarction, recurrent angina, ischemic stroke) was observed with ridogrel: 13% versus 19% in the aspirin group (a 32% reduction; P < .025). No excess of serious bleeding complications, including hemorrhagic stroke, was found.

CONCLUSIONS

Ridogrel is not superior to aspirin in enhancing the fibrinolytic efficacy of streptokinase but might be more effective in preventing new ischemic events.

摘要

背景

阿司匹林通过非选择性地阻断血小板和内皮细胞中的环氧化酶，不仅抑制血小板活化的血栓素A2途径，同时也抑制内皮细胞产生血管舒张和抑制血小板的前列腺素，如前列环素。利度格雷通过抑制血栓素A2合酶并阻断血栓素A2/前列腺素内过氧化物受体，是一种比阿司匹林更强效的抗血小板药物，作为溶栓辅助药物可能比阿司匹林更具优势。本研究旨在比较利度格雷与阿司匹林作为急性心肌梗死患者溶栓联合治疗的疗效和安全性。

方法与结果

总共907例急性心肌梗死患者被随机分为接受阿司匹林和利度格雷治疗组，两组均联合链激酶（1小时内给予150万单位）。主要终点是入院后7至14天进行的出院前血管造影时的冠状动脉通畅情况（TIMI血流分级2级和3级）。两个治疗组中发现梗死相关血管通畅的患者比例相似：利度格雷组为72.2%，阿司匹林组为75.5%。两组在2小时时再灌注的临床标志物出现情况以及住院期间主要临床事件的发生率也相似。然而，在事后分析中，观察到利度格雷组新缺血事件（再梗死、复发性心绞痛、缺血性卒中）的发生率较低：阿司匹林组为19%，利度格雷组为13%（降低32%；P<0.025）。未发现包括出血性卒中在内的严重出血并发症增加。