普拉格雷
氯吡格雷
医学
内科学
经皮冠状动脉介入治疗
药效学
蒂米
心肌梗塞
急性冠脉综合征
噻吩吡啶
装载剂量
心脏病学
随机对照试验
质子抑制剂泵
临床终点
药代动力学
作者
Michelle L. O’Donoghue,Eugene Braunwald,Elliott M. Antman,Sabina A. Murphy,Eric R. Bates,Yoseph Rozenman,Alan D. Michelson,Raymond W.M. Hautvast,Peter N Ver Lee,Sandra Close,Lei Shen,Jessica L. Mega,Marc S. Sabatine,Stephen D. Wiviott
出处
期刊:The Lancet
[Elsevier]
日期:2009-09-01
卷期号:374 (9694): 989-997
被引量:666
标识
DOI:10.1016/s0140-6736(09)61525-7
摘要
Proton-pump inhibitors (PPIs) are often prescribed in combination with thienopyridines. Conflicting data exist as to whether PPIs diminish the efficacy of clopidogrel. We assessed the association between PPI use, measures of platelet function, and clinical outcomes for patients treated with clopidogrel or prasugrel.In the PRINCIPLE-TIMI 44 trial, the primary outcome was inhibition of platelet aggregation at 6 h assessed by light-transmission aggregometry. In the TRITON-TIMI 38 trial, the primary endpoint was the composite of cardiovascular death, myocardial infarction, or stroke. In both studies, PPI use was at physician's discretion. We used a multivariable Cox model with propensity score to assess the association of PPI use with clinical outcomes.In the PRINCIPLE-TIMI 44 trial, 201 patients undergoing elective percutaneous coronary intervention were randomly assigned to prasugrel (n=102) or high-dose clopidogrel (n=99). Mean inhibition of platelet aggregation was significantly lower for patients on a PPI than for those not on a PPI at 6 h after a 600 mg clopidogrel loading dose (23.2+/-19.5% vs 35.2+/-20.9%, p=0.02), whereas a more modest difference was seen with and without a PPI after a 60 mg loading dose of prasugrel (69.6+/-13.5% vs 76.7+/-12.4%, p=0.054). In the TRITON-TIMI 38 trial, 13,608 patients with an acute coronary syndrome were randomly assigned to prasugrel (n=6813) or clopidogrel (n=6795). In this study, 33% (n=4529) of patients were on a PPI at randomisation. No association existed between PPI use and risk of the primary endpoint for patients treated with clopidogrel (adjusted hazard ratio [HR] 0.94, 95% CI 0.80-1.11) or prasugrel (1.00, 0.84-1.20).The current findings do not support the need to avoid concomitant use of PPIs, when clinically indicated, in patients receiving clopidogrel or prasugrel.Daiichi Sankyo Company Limited and Eli Lilly and Company sponsored the trials. This analysis had no funding.
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