替格瑞洛临床应用中国专家共识

《》[e-mail]··Ｒ735．37Adoi10．16680/j．1671-3826．2016．05．021671-3826201605-0444-10、、。P2Y12acutecoronarysyndromesACSpercutaneouscoronaryinterventionPCI。P2Y12、、PLATOACS12011ACS2-5。201211STACSnonST-elevationacutecoronarysyndromesNSTE-ACS、PCISTST-elevationmyocardialinfarctionSTEMI6-8。、。1、P2Y12P450cyto-chromeP450CYP2C1936%9。2h10.9～14.9h10。111。、PCI12-13。sta-blecoronaryarterydiseaseSCADONSET/OFFSET0.5hinhibitionofplateletaggregationIPA41%8%2h98%IPA＞50%90%IPA＞70%31%16%14。ACS0.5、2、8、24h6IPA2hIPA4.948.2%9.8%24hP2Y12P2Y12reactionunitPＲU＜240100%75.9%15。P2Y12、16。11/d2/d2～8h30min4h7～10d3～5dP2Y12。-1·444·20165445ClinJMedOfficVol.44No.5May2016171819、20、myocardialinfarctionMI21、22。。、19。22.1STEMISTEMI、。、。1180mg90mg、2/d2312。PLATOSTEMISTEMI843042014229。9.3%11.0%P=0.020PLATO23。ATLANTICPCI24h00.8%P=0.00830d0.2%1.2%P=0.020PCITIMIST24。MOJITOSTE-MI25。。STEMIPCI300mg180mg300mg600mgPCITIMI、126。2.2NSTE-ACSNSTE-ACSNSTEMI5。。1、180mg90mg2/d2180mg90mg2/d312。PLATONSTE-ACS1108010d74%46.0%PCI5%coronaryarterybypassgraft-ingCABG48.4%。10.0%12.3%P=0.0014.3%5.8%P=0.00213.4%12.6%P=0.260。NSTE-ACS27。2.3CABGACSCABG。。1ACSCABG5d5dⅡb/ⅢaglycoproteinⅡb/ⅢareceptorinhibitorGPI23CABG。PLATO10%CABG12617d。1～3d5d·544·20165445ClinJMedOfficVol.44No.5May2016。4.1%7.9%P=0.00924.7%9.7%P=0.0018CABG81.2%80.1%P=0.669128。CABG、29。2.4ACS1ACS、chronickid-neydiseaseCKD180mg90mg2/d122。3≥754CYP2C19、。2.4.130-31。ACS1.8MI1.432。33-34。ACS35。。PLATO46621036。P=0.490≥6.8mmol/L＜6.8mmol/LP=0.520。≥6.0%1.8%1.8%36。2.4.2CKDCKDACSCKD37。CKD。ACSCKD38-39。1.0%。creatinineclearanceCrCl＜30ml/min、40。PLATOCKD3237CKDCrCl＜60ml/minACS17.3%22.0%P＜0.0510.0%14.0%P＜0.0515.1%14.3%P＞0.05。ACSCKD41。PLATO。、。27242015dPＲU137.7310.4P＜0.00142。。2.4.343＞20mm、＞90°·644·20165445ClinJMedOfficVol.44No.5May2016、、、、、。PLATO15388464630.0%。15.0%14.9%17.6%P＜0.052.7%1.2%。。ACS44。2.4.4≥75。ACS/。。PLATO≥752878＜7515744、、、、45。2.4.5“”。CYP2C19。CYP2C19、、。18.0%～45.0%2.0%～15.0%46。50.0%、13.0%～23.0%46。ＲESPONDSCAD600mg75mg1/d259.0%35.0%P＜0.000147。10247.06%24hPＲU44.38±40.26212.58±52.34P＜0.0148。PLATO10285ACSCYP2C19CYP2C19CYP2C1930d5.7%3.8%P=0.02811.9%9.5%P=0.0229。2.4.6ACSPCI。TIMIGＲACECＲUSADE49。1-24～6343、drugelutingstentDES12DES645～7d55d。·744·20165445ClinJMedOfficVol.44No.5May201633.1PLATO11.6%11.2%P=0.43CABG4.5%3.8%P=0.031。。1、、2/、、、、-3≥75、、protonpumpinhibitorPPI4、PCI、CABG5P2Y12。。。。。Ⅶa。50-52。3.2。PLATO14.5%0.4%。23d43dP＜0.00010.9%53。ACSPCI14.3%3.3%P=0.31054。1/2、34。、、、55。3dACS。3d55。3.31、23。PLATO2908·844·20165445ClinJMedOfficVol.44No.5May2016ACS≥3s。1。、、56。PLATO。PLATO196.0%β33.0%4.0%1。3.412。PLATO1、12P＜0.00111。Butler57、、。。44.11ACS180mg90mg2/d2300～600mg。ＲESPONDIPA26.4%IPA24.5%47。PLATO1。ACS-58。PLATO46.0%79.1%300mg180mg1。ACS59。603d17.6%25.7%P=0.008。4.2121。TWICE2/d124hIPA1d2IPA1d61。4.34.3.1300mg100mg/d。PLATO＞100mg/d。75～100mg/d。。、。4.3.2GPIGPI、。·944·20165445ClinJMedOfficVol.44No.5May2016PLATO50.0%、25.0%GPI。1。。、。4.3.3。PLATO。ACS+++62。4.3.4PPI、。ACSPPI。PPIPPICYP2C19PPI。CYP2C19PPI63。PLATOPPI113。5PEGASUS211621～3≥160mg2/d、90mg2/d33。60、90mg3、TIMI3＜1%3。60mg90mg-64。PEGASUSSCAD。61970ACSACS、296.1%65。1200PCIACS654。ACS“”ACS“”。·054·20165445ClinJMedOfficVol.44No.5May2016○1WallentinLBeckerＲCBudajAetal．Ticagrelorversusclopi-dogrelinpatientswithacutecoronarysyndromesJ．NEnglJMed2009361111045-1057．DOI10．1056/NEJ-Moa0904327．2HammCWBassandJPAgewallSetal．ESCGuidelinesforthemanagementofacutecoronarysyndromesinpatientspresentingwithoutpersistentST-segmentelevationTheTaskForceforthemanagementofacutecoronarysyndromesACSinpatientspres-entingwithoutpersistentST-segmentelevationoftheEuropeanSo-cietyofCardiologyESCJ．EurHeartJ201132232999-3054．DOI10．1093/eurheartj/ehr236．3O'GaraPTKushnerFGAscheimDDetal．2013ACCF/AHAguidelineforthemanagementofST-elevationmyocardialinfarc-tionareportoftheAmericanCollegeofCardiologyFoundation/A-mericanHeartAssociationTaskForceonpracticeguidelinesJ．JAmCollCardiol2013614e78-e140．DOI10．1016/j．jacc．2012．11．019．4WindeckerSKolhPAlfonsoFetal．2014ESC/EACTSGuide-linesonmyocardialrevascularizationTheTaskForceonMyocar-dialＲevascularizationoftheEuropeanSocietyofCardiologyESCandtheEuropeanAssociationforCardio-ThoracicSurgeryEACTSDevelopedwiththespecialcontributionoftheEuropeanAssociationofPercutaneousCardiovascularInterventionsEAP-CIJ．EurHeartJ201435372541-2619．DOI10．1093/eurheartj/ehu278．5AmsterdamEAWengerNKBrindisＲGetal．2014AHA/ACCguidelineforthemanagementofpatientswithnon-ST-elevationa-cutecoronarysyndromesareportoftheAmericanCollegeofCar-diology/AmericanHeartAssociationTaskForceonpracticeguide-linesJ．Circulation201413025e344-e426．DOI10．1161/CIＲ．0000000000000134．6．STJ．2012405353-367．DOI10．3760/cma．j．issn．0253-3758．2012．05．001．7．2012J．2012404271-277．DOI10．3760/cma．j．issn．0253-3758．2012．04．003．8．STJ．2015435380-393．DOI10．3760/cma．j．issn．0253-3758．2015．05．003．9WallentinLJamesSStoreyＲFetal．EffectofCYP2C19andABCB1singlenucleotidepolymorphismsonoutcomesoftreatmentwithticagrelorversusclopidogrelforacutecoronarysyndromesageneticsubstudyofthePLATOtrialJ．Lancet201037697491320-1328．DOI10．1016/S0140-67361061274-3．10LiHButlerKYangLetal．Pharmacokineticsandtolerability