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引用次数: 2
摘要
替格瑞洛是一种直接作用、口服、可逆结合的P2Y(12)受体拮抗剂。作为一种环戊基三唑嘧啶,替格瑞洛代表了一种不需要代谢激活并具有一致抑制血小板聚集能力的新型化学药物。III期PLATO研究在18624例急性冠状动脉综合征患者中评估了替格瑞洛与氯吡格雷的比较,并证明替格瑞洛显著降低了血管原因/心肌梗死(MI)/卒中死亡风险(9.8% vs. 11.7%;人力资源:0.84;95% ci: 0.77-0.92;p < 0.001),没有显著增加柏拉图定义的大出血(分别为11.6%和11.2%;P = 0.43)。心肌梗死和血管原因死亡分别显著减少,任何原因死亡和支架血栓形成减少均达到名义统计学意义。在几乎所有患者亚组中,替格瑞洛均优于氯吡格雷,包括随机接受氯吡格雷的患者、计划进行侵入性或非侵入性治疗的患者;ST段抬高型心肌梗死(STEMI)患者、非STEMI患者和接受搭桥手术的患者。因此,PLATO人群特别反映了那些通常在临床环境中接受噻吩吡啶类抗血小板治疗的患者。
Antiplatelet therapy in acute coronary syndromes: ticagrelor.
Ticagrelor is a direct-acting, oral, reversibly binding P2Y(12) receptor antagonist. As a cyclopentyltriazolopyrimidine, ticagrelor represents a new chemical class of agents that do not require metabolic activation and have consistent ability to inhibit platelet aggregation. The phase III PLATO study evaluated ticagrelor compared with clopidogrel in 18,624 patients with acute coronary syndromes, and demonstrated a significant reduction in the risk of death from vascular causes/myocardial infarction (MI)/stroke with ticagrelor (9.8 vs. 11.7% with clopidogrel; HR: 0.84; 95% CI: 0.77-0.92; p < 0.001) without a significant increase in PLATO-defined major bleeding (11.6 vs. 11.2%, respectively; p = 0.43). MI and death from vascular causes were separately significantly reduced, and death from any cause and stent thrombosis reductions achieved nominal statistical significance. Ticagrelor showed benefit over clopidogrel in almost all patient subgroups, including patients who had received clopidogrel at randomization, patients with both planned invasive or noninvasive treatment; patients with ST elevation myocardial infarction (STEMI) referred for primary percutaneous coronary intervention, patients with non-STEMI, and patients who underwent bypass surgery. Hence, the PLATO population reflected specifically those patients who would ordinarily receive thienopyridine-based antiplatelet therapy in a clinical setting.