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首页> 外文期刊>The American Journal of Cardiology >Aspirin, clopidogrel, and ticagrelor in acute coronary syndromes
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Aspirin, clopidogrel, and ticagrelor in acute coronary syndromes

机译：阿司匹林，氯吡格雷和替卡格雷在急性冠脉综合征中的作用

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Dual antiplatelet therapy is the cornerstone in the management of patients with acute coronary syndromes (ACS). Ticagrelor, an oral, direct, reversibly binding, P2Y12 receptor antagonist, is approved for the prevention of atherothrombotic events in adult patients with ACS. In the PLATelet inhibition and patient Outcomes (PLATO) trial, ticagrelor was associated with significant reductions in cardiovascular events, cardiovascular mortality, and all-cause mortality compared with clopidogrel. A subanalysis of PLATO trial data identified a geographic region interaction (p = 0.045), indicating reduced efficacy of ticagrelor versus clopidogrel in North American patients. This effect could be due to chance, but may be explained by an interaction of ticagrelor with high aspirin doses, which are commonly used in the United States. In patients taking low-dose maintenance aspirin, ticagrelor was more effective than clopidogrel in decreasing cardiovascular events regardless of the geographic region. A proposed hypothetical mechanism for the interaction between ticagrelor and higher aspirin dose is linked to the level of P2Y 12 inhibition and the potential prothrombotic effects of high-dose aspirin through the suppression of prostacyclin. A review of data regarding aspirin use for secondary prevention of events in ACS demonstrated that low aspirin doses (75 to 160 mg/day) are consistently favored for short- and long-term use because of the lack of a dose-response relationship between increasing aspirin dose and improved efficacy, and a higher incidence of gastrointestinal bleeding with increasing aspirin dose. The use of low aspirin doses reflects good clinical practice and is encouraged in current guidelines.
机译：双重抗血小板治疗是治疗急性冠脉综合征（ACS）患者的基石。替卡格雷（Ticagrelor）是一种口服，直接，可逆结合的P2Y12受体拮抗剂，已被批准用于预防ACS成年患者的血栓形成事件。在PLATelet抑制和患者结果（PLATO）试验中，与氯吡格雷相比，替卡格雷可显着降低心血管事件，心血管死亡率和全因死亡率。 PLATO试验数据的子分析确定了地理区域的相互作用（p = 0.045），表明替卡格雷与氯吡格雷在北美患者中的疗效降低。这种作用可能是偶然的，但可以通过替卡格雷与高剂量阿司匹林的相互作用来解释，这在美国很普遍。在服用低剂量维持阿司匹林的患者中，无论地理区域如何，替加格雷在减少心血管事件方面比氯吡格雷更有效。替卡格雷与更高剂量的阿司匹林之间相互作用的拟议假想机制与P2Y 12抑制水平和大剂量阿司匹林通过抑制前列环素的潜在血栓形成作用有关。一项有关阿司匹林用于ACS的二级预防的数据的综述表明，由于长期服用阿司匹林之间缺乏剂量反应关系，因此长期和短期使用阿司匹林低剂量（75至160 mg /天）阿司匹林剂量和疗效提高，并且随着阿司匹林剂量的增加胃肠道出血的发生率更高。低剂量阿司匹林的使用反映了良好的临床实践，并在当前指南中得到鼓励。

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