Approaching an age of reason with antiplatelet therapy.

摘要

The antiplatelet drug prasugrel is one of a new generation of thienopyridines, drugs that inhibit the platelet P2Y12 receptor. With its increased active metabolite formation, prasugrel provides more rapid and consistent platelet inhibition than does clopidogrel.12The recently published TRITON-TIMI 38 trial was the first large-scale study to assess prasugrel in patients with acute coronary syndromes undergoing percutaneous coronary intervention. The trial established that the number of ischaemic events could be reduced by increasing the potency of platelet-inhibition. However, this was at the cost of an increased risk of major bleeding, especially in certain vulnerable subgroups.3 An important and prespecified subgroup analysis of TRITON-TIMI 38, focusing on patients who received coronary stents, is reported in today's Lancet.4 The so-called subgroup actually comprises 94% of the main study population, with outcomes similar to those in the main TRITON-TIMI 38 trial-an identical 0-81 hazard ratio for prasugrel versus clopidogrel for the primary ischaemic endpoint of cardiovascular death, non-fatal myocardial infarction, and stroke.