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首页 » 生物研究 » Circ-Cardiovasc Inte:替卡格雷与普拉格雷对患者的影响

Circ-Cardiovasc Inte:替卡格雷与普拉格雷对患者的影响

来源:医学界 2013-07-16 16:20

相比于氯吡格雷(clopidogrel),普拉格雷(Prasugrel)和替卡格雷( ticagrelor)有更加优越的抗心肌缺血作用。替卡格雷的作用可能归因于腺苷介导机制分子机制。近日,发表于Circulation: Cardiovascular Interventions上的一篇研究旨在比较替卡格雷与普拉格雷在增加静脉注射腺苷剂量的时候对冠状动脉血流速度的作用。

这是一项前瞻性单中心单盲的交叉研究。研究纳入了56例经皮冠状动脉介入后的非ST段抬高急性冠脉综合征患者。经过随机分组,患者接受替卡格雷90毫克BID或普拉格雷10毫克OD 15天的治疗。

在每个治疗周期结束后,研究通过经胸多普勒超声心动图CBFV评估在基线和以及)输注腺苷(每分钟50微克/公斤;每分钟80微克/千克;每分钟110微克/公斤和每分钟140微克/公斤)下冠脉血流的变化。

研究结果提示,采用替卡格雷治疗比采用普拉格雷治疗的患者CBFV曲线下最大面积较高,平均差异为7.16(95%可信区间为2.61-11.7,P=0.003)。

最大CBFV与基线CBFV的比值,在每分钟50微克/公斤,每分钟80微克/千克,每分钟110微克/公斤剂量时替卡格雷比普拉格雷较高,但在每分钟140微克/公斤时普拉格雷较高。各组比较的均数差(95%可信区间)分别为0.17(0.08 -0.26,P<0.001),0.21(0.02-0.41,P= 0.03),0.24(0.01-0.47,P= 0.04)和0.14(0.1-0.4,P= 0.3)。

研究结果提示,对接受经皮冠状动脉介入治疗的非ST段抬高的急性冠脉综合征患者,使用腺苷时,替卡格雷增强CBFV的程度大于普拉格雷。这些结果表明替卡格雷作用的多效性,提示可能有助于此类患者。(生物谷Bioon.com)

生物谷推荐英文摘要:

Circ-Cardiovasc Inte          doi: 10.1161/CIRCINTERVENTIONS.113.000293

Differential Effect of Ticagrelor Versus Prasugrel on Coronary Blood Flow Velocity in Patients With Non–ST-Elevation Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention

Dimitrios Alexopoulos, MD, PhD, FESC, Athanasios Moulias, MD, Nikolaos Koutsogiannis, MD, Ioanna Xanthopoulou, MD, Apostolos Kakkavas, MD, Eleni Mavronasiou, Periklis Davlouros, and George Hahalis

Background—Prasugrel and ticagrelor provide a superior anti-ischemic action than clopidogrel, with some of ticagrelor’s benefits possibly attributed to adenosine-mediated mechanisms. We aimed to compare the effect of maintenance dose of ticagrelor versus prasugrel on coronary blood flow velocity (CBFV) during increasing doses of intravenously administered adenosine.

Methods and Results—In a prospective, single-center, single-blind, crossover study, 56 patients with non–ST-elevation acute coronary syndrome undergoing percutaneous coronary intervention were randomized to receive either ticagrelor 90 mg BID or prasugrel 10 mg OD with a 15-day treatment period. At the end of each treatment period, CBFV by transthoracic Doppler echocardiography was assessed at baseline and under incremental doses (50 μg/kg per minute, 80 μg/kg per minute, 110 μg/kg per minute, and 140 μg/kg per minute) of adenosine infusion. Maximal CBFV area under the curve was higher for ticagrelor-treated than for prasugrel-treated patients, with a least squares mean difference of 7.16 (95% confidence interval, 2.61–11.7; P=0.003). Maximal CBFV/baseline CBFV ratio was higher with ticagrelor than prasugrel at 50, 80, and 110 μg/kg per minute but not at 140 μg/kg per minute adenosine infusion rate, with mean difference (95% confidence interval) of 0.17 (0.08–0.26; P<0.001), 0.21 (0.02–0.41; P=0.03), 0.24 (0.01–0.47; P=0.04), and 0.14 (?0.12 to 0.4; P=0.3), respectively.

Conclusions—In patients with non–ST-elevation acute coronary syndrome undergoing percutaneous coronary intervention, ticagrelor augments CBFV to a greater extent than prasugrel when incremental doses of adenosine are administered. Although exploratory, these results may represent a pleiotropic action of ticagrelor, possibly contributing to its beneficial effects in such patients.

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