Abstract
Dual antiplatelet therapy (DAPT) with aspirin and one of inhibitors of P2Y12receptors (clopidogrel, ticagrelor, prasugrel) is an international standard of receptors (clopidogrel, ticagrelor, prasugrel) is an international standard of is an international standard of treatment strategy in patients with acute coronary syndrome (ACS). to analyze experience of prasugrel use in the National Medical Cardiology Research Center in comparison to similar groups of patients treated with other P2Y12inhibitors for determination of optimal place of DAPT with prasugrel in ACS patients.Materials and methods.We included in this retrospective study 40 patients who received therapy with prasugrel, ticagrelor, or clopidogrel in connection with urgent percutaneous coronary intervention (PCI) performed in the Department of Urgent Cardiology from May to December 2018. We analyzed specific characteristics of prasugrel treated patients including disease history, features of clinical presentation and coronary anatomy, use of strategies of escalation and de-escalation, as well as inhospital mortality, development of complications and side effects.Results.New P2Y12inhibitors were more effective in patients with higher risk of atherothrombosis compared with risk of bleeding. Median of implanted stents in ticagrelor and clopidogrel groups was equal to 1, in the prasugrel group - 2 stents per PCI. When multivascular stenting was performed the choice usually was made in favor of prasugrel or ticagrelor, excluding cases with presence of limiting factors - use of oral anticoagulants (OAC) (n=4) and prehospital thrombolytic therapy (n=5). Of note was close to statistical significance high number of side effects related to ticagrelor use (n=3, 23.08%, p=0.057). There were no significant differences between groups in rates of unfavorable outcomes and complications.Conclusion.Administration of prasugrel can be considered in patients with high risk of atherothrombosis: with diabetes, with large number of implantable stents. The choice between ticagrelor and prasugrel can be made with consideration of the potential for side effects that significantly impair the quality of life of patients. Main limitations for application of both prasugrel and ticagrelor are the need to permanent use of OAC, prehospital thrombolytic therapy, and higher cost compared to clopidogrel.
Highlights
Dual antiplatelet therapy (DAPT) with aspirin and one of inhibitors of P2Y12 receptors is an international standard of receptors is an international standard of is an international standard of treatment strategy in patients with acute coronary syndrome (ACS)
There were no significant differences between groups in rates of unfavorable outcomes and complications
Исследование было досрочно прекращено в связи с повышенным риском кровотечений в группе раннего назначения прасугрела при сопоставимой частоте событий первичной конечной точки, включавшей сердечнососудистую смерть, инфаркт миокарда (ИМ), инсульт, экстренную реваскуляризацию или необходимость терапии «спасения» ингибиторами рецепторов IIb / IIIa тромбоцитов [9]
Summary
Dual antiplatelet therapy (DAPT) with aspirin and one of inhibitors of P2Y12 receptors (clopidogrel, ticagrelor, prasugrel) is an international standard of receptors (clopidogrel, ticagrelor, prasugrel) is an international standard of is an international standard of treatment strategy in patients with acute coronary syndrome (ACS). We included in this retrospective study 40 patients who received therapy with prasugrel, ticagrelor, or clopidogrel in connection with urgent percutaneous coronary intervention (PCI) performed in the Department of Urgent Cardiology from May to December 2018. Показания и противопоказания к применению того или иного антиагреганта различаются, и, соответственно, каждый из них занимает свою нишу среди различных когорт пациентов, которым выполнялось ЧКВ. Однако среди всех вариантов смены антиагреганта лишь эскалация терапии с клопидогрела на тикагрелор проверена в рандомизированных клинических исследованиях (РКИ). Целью настоящего исследования стал анализ полученных результатов, которые будут представлены в сравнении со сходными группами пациентов, получающих терапию другими ингибиторами P2Y12, для определения оптимального места прасугрела в двухкомпонентной антитромбоцитарной терапии (ДАТТ) у пациентов, подвергающихся ЧКВ, среди других антитромбоцитарных препаратов. В группы сравнения были набраны по 13 пациентов, получавших тикагрелор или клопидогрел и наблюдавшихся в блоке интенсивной терапии и в отделении в тот же промежуток времени.
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