ПРАСУГРЕЛ В ЛЕЧЕНИИ ПАЦИЕНТОВ С ОСТРЫМ КОРОНАРНЫМ СИНДРОМОМ И ЧРЕСКОЖНЫМ КОРОНАРНЫМ ВМЕШАТЕЛЬСТВОМ: СОВРЕМЕННОЕ СОСТОЯНИЕ ПРОБЛЕМЫ

Прасугрел представляет собой тиенопиридин третьего поколения, обеспечивающий по сравнению с клопидогрелом более быстрое наступление эффекта, меньшую вероятность нечувствительности к действию препарата, большую степень ингибирования АДФ-индуцированной агрегации тромбоцитов. Прасугрел следует назначать следующим категориям пациентов: 1) больным с ОКС с подъемом сегмента ST, подвергаемых первичным чрескожным коронарным вмешательствам; 2) пациентам с ОКС с подъемом сегмента ST, которым был выполнен тромболизис, но планируется проведение отсроченного ЧКВ; 3) пациентам с ОКС без подъема сегмента ST с известной коронарной анатомией, которым планируется проведение ЧКВ; 4) пациентам, перенесшим тромбоз стента на фоне приема клопидогрела. Назначение прасугрела может быть рассмотрено и у больных со стабильной ИБС в случае высокого риска тромбоза стента после планового ЧКВ. Следует избегать назначения этого препарата пациентам с инсультом или ТИА в анамнезе, а также больным старше 75 лет и массой тела менее 60 кг. Наилучшие результаты применения прасугрела ожидаются у больных младше 60 лет, с ИМ с подъемом сегмента ST, сопутствующим сахарным диабетом, клиренсом креатинина не ниже 60 мл/мин. В статье также рассмотрены современные представления о «деэскалации» терапии прасугрелом, представлены опубликованные к настоящему моменту данные о сравнительной эффективности и безопасности прасугрела и тикагрелора.

1. Farid NA, Kurihara A, Wrighton SA. Metabolism and disposition of the thienopyridine antiplatelet drugs ticlopidine, clopidogrel, and prasugrel in humans. J Clin Pharmacol, 2010, 50: 126–142. doi: 10.1177/0091270009343005.

2. O’Gara PT, Kushner FG, Ascheim DD et al. 2013 ACCF / AHA Guideline for the Management of ST-Elevation Myocardial Infarction. Circulation, 2013, 127: e362-e425.

3. Ibanez B, James S, Agewall S et al. ESC Scientific Document Group, 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). European Heart Journal, 2018 January 7, 39 (Issue 2): 119–177. https://doi.org/10.1093/eurheartj/ehx393

4. Amsterdam EA, Wenger NK, Brindis RG et al. 2014 AHA / ACC Guideline for the Management of Patients With Non – ST-Elevation Acute Coronary Syndromes: Executive Summary. Circulation, 2014, 130: 2354–2394.

5. Roffi M, Patrono C, Collet J-P et al. 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC). European Heart Journal, 2016 January14, 37 (Issue 3): 267–315. https://doi.org/10.1093/eurheartj/ehv320

6. Valgimigli M, Bueno H, Byrne RA et al. 2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS. European Heart Journal, 2017, 0: 1–48. doi: 10.1093/eurheartj/ehx419.

7. Wiviott SD, Braunwald E, McCabe CH et al. Prasugrel versus clopidogrel in patients with acute coronary syndromes. N Engl J Med, 2007, 357 (20): 2001–2015.

8. Wilcox R, Iqbal K, Costigan T et al. An analysis of TRITON-TIMI 38, based on the 12 month recommended length of therapy in the European label for prasugrel. Curr Med Res Opin, 2014, 30: 2193–205. doi: 10.1185/03007995.2014.944638.

9. Montalescot G, Bolognese L, Dudek D et al. ACCOAST Investigators. Pretreatment with prasugrel in non-ST-segment elevation acute coronary syndromes. N Engl J Med, 2013, 369: 999–1010. doi: 10.1056/NEJMoa1308075.

10. Antman EM, Wiviott SD, Murphy SA et al. Early and late benefits of Prasugrel in patients with acute coronary syndromes undergoing percutaneous coronary intervention: a TRITON-TIMI 38 (TRial to assess Improvement in Therapeutic Outcomes by optimizing platelet InhibitioN with Prasugrel-Thrombolysis In Myocardial Infarction) analysis. J Am Coll Cardiol, 2008, 51 (21): 2028–2033.

11. Angiolillo DJ, Rollini F, Storey RF et al. International Expert Consensus on Switching Platelet P2Y12 Receptor – Inhibiting Therapies. Circulation. 2017, 136: 1955–1975. doi: 10.1161/CIRCULATIONAHA.117.031 164.

12. Alexopoulos D, Xanthopoulou I, Deftereos S et al. In-hospital switching of oral P2Y12 inhibitor treatment in patients with acute coronary syndrome undergoing percutaneous coronary intervention: prevalence, predictors and short-term outcome. Am Heart J, 2014, 167: 68–76.e2. doi: 10.1016/j.ahj.2013.10.010.

13. Clemmensen P, Grieco N, Ince H et al. MULTIPRAC study investigators. MULTInational non-interventional study of patients with ST-segment elevation myocardial infarction treated with PRimary Angioplasty and Concomitant use of upstream antiplatelet therapy with prasugrel or clopidogrel: the European MULTIPRAC Registry. Eur Heart J Acute Cardiovasc Care, 2015, 4: 220–229. doi: 10.1177/2048872614547449.

14. Bagai A, Peterson ED, Honeycutt E et al. In-hospital switching between adenosine diphosphate receptor inhibitors in patients with acute myocardial infarction treated with percutaneous coronary intervention: insights into contemporary practice from the TRANSLATEACS study. Eur Heart J Acute Cardiovasc Care, 2015, 4: 499–508. doi: 10.1177/2048872614564082.

15. Schiele F, Puymirat E, Bonello L et al. Switching between thienopyridines in patients with acute myocardial infarction and quality of care. Open Heart, 2016, 3: e000384. doi: 10.1136/openhrt-2015–000384.

16. De Luca L, Leonardi S, Cavallini C et al. EYESHOT Investigators. Contemporary antithrombotic strategies in patients with acute coronary syndrome admitted to cardiac care units in Italy: the EYESHOT study. Eur Heart J Acute Cardiovasc Care, 2015, 4: 441–452. doi: 10.1177/2048872614560505.

17. Bagai A, Wang Y, Wang TY et al. In-hospital switching between clopidogrel and prasugrel among patients with acute myocardial infarction treated with percutaneous coronary intervention: insights into contemporary practice from the National Cardiovascular Data Registry. Circ Cardiovasc Interv, 2014, 7: 585–593. doi: 10.1161/CIRCINTERVENTIONS.114.001555.

18. Zettler ME, Peterson ED, McCoy LA et al. TRANSLATEACS Investigators. Switching of adenosine diphosphate receptor inhibitor after hospital discharge among myocardial infarction patients: insights from the Treatment with Adenosine Diphosphate Receptor Inhibitors: Longitudinal Assessment of Treatment Patterns and Events after Acute Coronary Syndrome (TRANSLATE-ACS) observational study. Am Heart J, 2017, 183: 62–68. doi: 10.1016/j.ahj.2016.10.006.

19. De Luca L, D’Ascenzo F, Musumeci G et al. Incidence and outcome of switching of oral platelet P2Y12 receptor inhibitors in patients with acute coronary syndromes undergoing percutaneous coronary intervention: the SCOPE registry. EuroIntervention, 2017, 13: 459–466. doi: 10.4244/EIJD-17–00092.

20. Cuisset T, Deharo P, Quilici J et al. Benefit of switching dual antiplatelet therapy after acute coronary syndrome: the TOPIC (Timing of Platelet Inhibition After Acute Coronary Syndrome) randomized study. Eur Heart J, 2017 Nov 1, 38 (41): 3070–3078. doi: 10.1093/eurheartj/ehx175.

21. Sibbing D, Aradi D, Jacobshagen C et al. Guided deescalation of antiplatelet treatment in patients with acute coronary syndrome undergoing percutaneous coronary intervention (TROPICAL-ACS): a randomised, open-label, multicentre trial. Lancet, 2017, 390: 1747– 1757. doi: 10.1016/S0140–6736(17)32155–4.

22. Motovska Z, Hlinomaz O, Miklik R et al. Prasugrel versus Ticagrelor in Patients with Acute Myocardial Infarction Treated with Primary Percutaneous Coronary Intervention. Multicenter Randomized PRAGUE-18 Study. Circulation, 2016 Nov 22, 134 (21): 1603–1612.

23. Motovska Z, Hlinomaz O, Kala P et al. 1-Year Outcomes of Patients Undergoing Primary Angioplasty for Myocardial Infarction Treated With Prasugrel Versus Ticagrelor. J Am Coll Cardiol, 2018 Jan 30, 71 (4): 371–381. doi: 10.1016/j.jacc.2017.11.008.

24. Bundhun PK, Shi J-X, Huang F. Head to head comparison of Prasugrel versus Ticagrelor in patients with acute coronary syndrome: a systematic review and meta-analysis of randomized trials. BMC Pharmacology and Toxicology, 2017, 18: 80. doi: 10.1186/s40360-017-0189–7.

25. Sakurai R, Burazor I, Bonneau HN, Kaneda H. Headtohead comparison of prasugrel versus ticagrelor in patients undergoing percutaneous coronary intervention: A meta-analysis of randomized controlled trials. J Interv Cardiol, 2017 Oct, 30 (5): 457–464. doi: 10.1111/joic.12416.

26. Larmore C, Effron MB, Molife C et al. «Real-world» comparison of prasugrel with ticagrelor in patients with acute coronary syndrome treated with percutaneous coronary intervention in the United States, Catheter. Cardiovasc. Interv., 2016, 88 (4): 535–544.

27. Danchin N, Lettino M, Zeymer U et al. Use, patient selection and outcomes of P2Y12 receptor inhibitor treatment in patients with STEMI based on contemporary European registries. Eur Heart J Cardiovasc Pharmacother, 2016, 2: 152–167. doi: 10.1093/ehjcvp/pvw003.

28. Rezaei SS, Geroldinger A, Heinze G et al. Clopidogrel, prasugrel, or ticagrelor use and clinical outcome in patients with acute coronary syndrome: A nationwide long-termregistry analysis from 2009 to 2014. International Journal of Cardiology, 2017, 235: 61–66.

29. Alexopoulos D, Xanthopoulou I, Deftereos S et al. Contemporary antiplatelet treatment in acute coronary syndrome patients undergoing percutaneous coronary intervention: one-year outcomes from the Greek AntiPlatelet Registry (GRAPE). J Thromb Haemost, 2016 Jun, 14 (6): 1146–54. doi: 10.1111/jth.13316.