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口服双重抗血小板药物阿司匹林加噻吩吡啶,已获准在经皮冠状动脉介入治疗(PCI)中使用。第二代噻吩吡啶类衍生物氯吡格雷是给予PCI患者双重抗血小板治疗的选择性药物。但是,氯吡格雷存在两个缺陷:①氯吡格雷需要代谢产生其活性的形式,故抗血小板活性延迟;②已证明不同患者给予氯吡格雷后的反应存在很大差异性。为了克服氯吡格雷的上述缺陷,新一代更有效的普拉格雷(即第三代噻吩吡啶类衍生物),临床评价其可以快速起效。本文对第三代口服噻吩吡啶普拉格雷进行了综述,旨在总结普拉格雷的利弊并概述该药在临床使用中最谨慎的方案。
Oral dual antiplatelet medication aspirin plus thiophene pyridine has been approved for use in percutaneous coronary intervention (PCI). Clopidogrel, a second generation thiophene derivative, is a selective drug for dual antiplatelet therapy in PCI patients. However, there are two drawbacks to clopidogrel: clopidogrel needs to be metabolized to produce its active form, so that there is a delay in antiplatelet activity; and it has been demonstrated that the response to clopidogrel in different patients is quite different. In order to overcome the above defects of clopidogrel, a new generation of more effective prasugrel (that is, the third generation of thiophene pyridine derivatives), clinical evaluation of its rapid onset. This review summarizes the third generation of oral thiophene-treated prasugrel, aiming to summarize the pros and cons of prasugrel and to outline the most cautious approach to its use in clinical practice.