cardiovascularКардиоваскулярная терапия и профилактикаCardiovascular Therapy and Prevention1728-88002619-0125«SILICEA-POLIGRAF» LLC10.15829/1728-8800-2011-5-87-91cardiovascular-1945Research ArticleМНЕНИЕ ПО ПРОБЛЕМЕOPINION ON A PROBLEMДвойная антитромбоцитарная терапия больных с острым коронарным синдромомDouble antiplatelet therapy in patients with acute coronary syndromeРодионовА. В.RodionovA. V.

Москва, Тел./факс: +7 (499) 248-57-90

Moscow

ftk-consult@mma.ruАйнетдиноваД. Х.AynetdinovaD. Kh.

Москва

Moscow

СулимовВ. А.SulimovV. A.

Москва

Moscow

ГОУ ВПО Первый Московский государственный медицинский университет им. И.М.СеченоваI.M. Sechenov First Moscow State Medical University2011201020111058791Copyright © Родионов А.В., Айнетдинова Д.Х., Сулимов В.А., 20112011Родионов А.В., Айнетдинова Д.Х., Сулимов В.А.Rodionov A.V., Aynetdinova D.K., Sulimov V.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://cardiovascular.elpub.ru/jour/article/view/1945

The paper presents the evolution in the modern approaches towards antiplatelet therapy (aspirin, clopidogrel) in acute coronary syndrome, as well as the results of the studies on effectiveness and safety of such new antiaggregant medications as prasugrel and ticagrelor.

острый коронарный синдромантиагрегантыантитромбоцитарная терапиярезистентностьаспиринклопидогрелпрасугрелтикагрелорAcute coronary syndromeanti-aggregantsantiplatelet therapyresistanceaspirinclopidogrelprasugrelticagrelorReferencesBraunwald E, Antman EM, Beasley JW, et al. ACC/AHA 2002 guideline update for the management of patients with unstable angina and non-ST-segment elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Unstable Angina) 2002.Braunwald E, Antman EM, Beasley JW, et al. ACC/AHA 2002 guideline update for the management of patients with unstable angina and non-ST-segment elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Unstable Angina) 2002.Antithrombotic Trialists’ Collaboration. Collaborative metaanalysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high-risk patients. BMJ 2002; 324: 71-86.Antithrombotic Trialists’ Collaboration. Collaborative metaanalysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high-risk patients. BMJ 2002; 324: 71-86.ISIS-2 (Second International Study of Infarct Survival) Collaborative Group. Randomised trial of intravenous streptokinase, oral aspirin, both, or neither among 17 187 cases of suspected acute myocardial infarction: ISIS-2. Lancet 1988; 332: 349-60.ISIS-2 (Second International Study of Infarct Survival) Collaborative Group. Randomised trial of intravenous streptokinase, oral aspirin, both, or neither among 17 187 cases of suspected acute myocardial infarction: ISIS-2. Lancet 1988; 332: 349-60.Yusuf S, Zhao F, Mehta SR, et al. The CURE Trial Investigators. Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation. N Engl J Med 2001; 345: 494-502.Yusuf S, Zhao F, Mehta SR, et al. The CURE Trial Investigators. Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation. N Engl J Med 2001; 345: 494-502.Steinhubl SR, Berger PB, Mann JT for the CREDO Investigators. Early and Sustained Dual Oral Antiplatelet Therapy Following Percutaneous Coronary Intervention. A Randomized Controlled Trial. JAMA 2002; 288: 2411-20.Steinhubl SR, Berger PB, Mann JT for the CREDO Investigators. Early and Sustained Dual Oral Antiplatelet Therapy Following Percutaneous Coronary Intervention. A Randomized Controlled Trial. JAMA 2002; 288: 2411-20.Sabatine MS, Cannon CP, Gibson CM, et al, the CLARITYTIMI 28 Investigators. Addition of clopidogrel to aspirin and fibrinolytic therapy for myocardial infarction with ST-segment elevation. N Engl J Med 2005; 352: 1179-89.Sabatine MS, Cannon CP, Gibson CM, et al, the CLARITYTIMI 28 Investigators. Addition of clopidogrel to aspirin and fibrinolytic therapy for myocardial infarction with ST-segment elevation. N Engl J Med 2005; 352: 1179-89.COMMIT collaborative group. Addition of clopidogrel to aspirin in 45 852 patients with acute myocardial infarction: randomised, placebo-controlled trial. Lancet 2005; 366: 1607-21.COMMIT collaborative group. Addition of clopidogrel to aspirin in 45 852 patients with acute myocardial infarction: randomised, placebo-controlled trial. Lancet 2005; 366: 1607-21.Montalescot G, Sideris G, Meuleman C, et al. A randomized comparison of high clopidogrel loading doses in patients with non-ST-segment elevation acute coronary syndromes: the ALBION (Assessment of the Best Loading Dose of Clopidogrel to Blunt Platelet Activation, Inflammation and Ongoing Necrosis) trial. JACC 2006; 48: 931-8.Montalescot G, Sideris G, Meuleman C, et al. A randomized comparison of high clopidogrel loading doses in patients with non-ST-segment elevation acute coronary syndromes: the ALBION (Assessment of the Best Loading Dose of Clopidogrel to Blunt Platelet Activation, Inflammation and Ongoing Necrosis) trial. JACC 2006; 48: 931-8.The CURRENT-OASIS 7 Investigators Dose Comparisons of Clopidogrel and Aspirin in Acute Coronary Syndromes N Engl J Med 2010; 363: 930-42.The CURRENT-OASIS 7 Investigators Dose Comparisons of Clopidogrel and Aspirin in Acute Coronary Syndromes N Engl J Med 2010; 363: 930-42.Guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for CardioThoracic Surgery (EACTS). Eur Heart J 2010; 31(20): 2501-55.Guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for CardioThoracic Surgery (EACTS). Eur Heart J 2010; 31(20): 2501-55.Collet J-P, Silvain J, Landivier A, et al. Dose effect of clopidogrel reloading in patients already on 75-mg maintenance dose: the Reload with clopidogrel before coronary Angioplasty in subjects treated long term with Dual antiplatelet therapy (RELOAD) study Circulation 2008;118: 1225-33.Collet J-P, Silvain J, Landivier A, et al. Dose effect of clopidogrel reloading in patients already on 75-mg maintenance dose: the Reload with clopidogrel before coronary Angioplasty in subjects treated long term with Dual antiplatelet therapy (RELOAD) study Circulation 2008;118: 1225-33.Guidelines for the diagnosis and treatment of non-ST-segment elevation acute coronary syndromes The Task Force for the Diagnosis and Treatment of Non-ST-Segment Elevation Acute Coronary Syndromes of the European Society of Cardiology. Eur Heart J 2007; 28: 1598-660.Guidelines for the diagnosis and treatment of non-ST-segment elevation acute coronary syndromes The Task Force for the Diagnosis and Treatment of Non-ST-Segment Elevation Acute Coronary Syndromes of the European Society of Cardiology. Eur Heart J 2007; 28: 1598-660.Montalescot G, Wiviott SD, Braunwald E, et al. for the TRITON-TIMI 38 investigators. Prasugrel compared with clopidogrel in patients undergoing percutaneous coronary intervention for ST-elevation myocardial infarction (TRITON-TIMI 38): double-blind, randomised controlled trial. Lancet 2009; 373: 723-31.Montalescot G, Wiviott SD, Braunwald E, et al. for the TRITON-TIMI 38 investigators. Prasugrel compared with clopidogrel in patients undergoing percutaneous coronary intervention for ST-elevation myocardial infarction (TRITON-TIMI 38): double-blind, randomised controlled trial. Lancet 2009; 373: 723-31.Wiviott SD, Trenk D, Frelinger AL, et al. Prasugrel compared with high loading- and maintenance-dose clopidogrel in patients with planned percutaneous coronary intervention. The Prasugrel in Comparison to Clopidogrel for Inhibition of Platelet Activation and Aggregation-Thrombolysis in Myocardial Infarction 44 Trial. Circulation 2007; 116: 2923-32.Wiviott SD, Trenk D, Frelinger AL, et al. Prasugrel compared with high loading- and maintenance-dose clopidogrel in patients with planned percutaneous coronary intervention. The Prasugrel in Comparison to Clopidogrel for Inhibition of Platelet Activation and Aggregation-Thrombolysis in Myocardial Infarction 44 Trial. Circulation 2007; 116: 2923-32.Chin CT, Roe MT, Fox KA, et al. TRILOGY ACS Steering Committee. Study design and rationale of a comparison of prasugrel and clopidogrel in medically managed patients with unstable angina/non-ST-segment elevation myocardial infarction: the TaRgeted platelet Inhibition to cLarify the Optimal strateGy to medicallY manage Acute Coronary Syndromes (TRILOGY ACS) trial. Am Heart J 2010; 160(1): 16-22.e1.Chin CT, Roe MT, Fox KA, et al. TRILOGY ACS Steering Committee. Study design and rationale of a comparison of prasugrel and clopidogrel in medically managed patients with unstable angina/non-ST-segment elevation myocardial infarction: the TaRgeted platelet Inhibition to cLarify the Optimal strateGy to medicallY manage Acute Coronary Syndromes (TRILOGY ACS) trial. Am Heart J 2010; 160(1): 16-22.e1.Management of acute myocardial infarction in patients presenting with persistent ST-segment elevation The Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology. Eur Heart J 2008; 29: 2909-45.Management of acute myocardial infarction in patients presenting with persistent ST-segment elevation The Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology. Eur Heart J 2008; 29: 2909-45.Husted S, Emanuelsson H, Heptinstall S, et al. Pharmacodynamics, pharmacokinetics, and safety of the oral reversible P2Y12 antagonist AZD6140 with aspirin in patients with atherosclerosis: a double-blind comparison to clopidogrel with aspirin. Eur Heart J 2006; 27: 1038-47.Husted S, Emanuelsson H, Heptinstall S, et al. Pharmacodynamics, pharmacokinetics, and safety of the oral reversible P2Y12 antagonist AZD6140 with aspirin in patients with atherosclerosis: a double-blind comparison to clopidogrel with aspirin. Eur Heart J 2006; 27: 1038-47.Cannon CP, Husted S, Harrington RA, et al. Safety, tolerability, and initial efficacy of AZD6140, the first reversible oral adenosine diphosphate receptor antagonist, compared with clopidogrel, in patients with non-ST-segment elevation acute coronary syndrome: primary results of the DISPERSE-2 trial. JACC 2007; 50: 1844-51.Cannon CP, Husted S, Harrington RA, et al. Safety, tolerability, and initial efficacy of AZD6140, the first reversible oral adenosine diphosphate receptor antagonist, compared with clopidogrel, in patients with non-ST-segment elevation acute coronary syndrome: primary results of the DISPERSE-2 trial. JACC 2007; 50: 1844-51.Wallentin L, Becker RC, Budaj A, et al. Ticagrelor versus Clopidogrel in Patients with Acute Coronary Syndromes. N Engl J Med 2009; 361: 1045-57.Wallentin L, Becker RC, Budaj A, et al. Ticagrelor versus Clopidogrel in Patients with Acute Coronary Syndromes. N Engl J Med 2009; 361: 1045-57.Cannon CP, Harrington RA, James S. Comparison of ticagrelor with clopidogrel in patients with a planned invasive strategy for acute coronary syndromes (PLATO): a randomised double-blind study. Lancet 2010; 375: 283-93.Cannon CP, Harrington RA, James S. Comparison of ticagrelor with clopidogrel in patients with a planned invasive strategy for acute coronary syndromes (PLATO): a randomised double-blind study. Lancet 2010; 375: 283-93.James S, Roe M, Cannon CP. Ticagrelor versus clopidogrel in patients with acute coronary syndromes intended for a non-invasive management in the PLATO trial. Presented at the European Society of Cardiology, Stockholm, 2010.James S, Roe M, Cannon CP. Ticagrelor versus clopidogrel in patients with acute coronary syndromes intended for a non-invasive management in the PLATO trial. Presented at the European Society of Cardiology, Stockholm, 2010.Farid NA, Payne CD, Small DS, et al. Cytochrome P450 3A inhibition by ketoconazole affects prasugrel and clopidogrel pharmacokinetics and pharmacodynamics differently. Clin Pharmacol Ther 2007; 81: 735-41.Farid NA, Payne CD, Small DS, et al. Cytochrome P450 3A inhibition by ketoconazole affects prasugrel and clopidogrel pharmacokinetics and pharmacodynamics differently. Clin Pharmacol Ther 2007; 81: 735-41.Hulot JS, Bura A, Villard E, et al. Cytochrome P450 2C19 lossof-function polymorphism is a major determinant of clopidogrel responsiveness in healthy subjects. Blood 2006; 108: 2244-7.Hulot JS, Bura A, Villard E, et al. Cytochrome P450 2C19 lossof-function polymorphism is a major determinant of clopidogrel responsiveness in healthy subjects. Blood 2006; 108: 2244-7.Wallentin L, James S, Storey RF, et al. Effect of CYP2C19 and ABCB1 single nucleotide polymorphisms on outcomes of treatment with ticagrelor versus clopidogrel for acute coronary syndromes: a genetic substudy of the PLATO trial. The Lancet, Early Online Publication, 29 August 2010.Wallentin L, James S, Storey RF, et al. Effect of CYP2C19 and ABCB1 single nucleotide polymorphisms on outcomes of treatment with ticagrelor versus clopidogrel for acute coronary syndromes: a genetic substudy of the PLATO trial. The Lancet, Early Online Publication, 29 August 2010.Kastrati A, Ndrepepa G. Cangrelor — A Champion Lost in Translation? N Engl J Med 2009; 361: 2382-4.Kastrati A, Ndrepepa G. Cangrelor — A Champion Lost in Translation? N Engl J Med 2009; 361: 2382-4.

The authors declare that there are no conflicts of interest present.