Circulation, Vol 89, 588-595, Copyright © 1994 by American Heart Association
BACKGROUND: Aspirin, by nonselectively blocking cyclooxygenase both in
platelets and in endothelial cells, not only inhibits the thromboxane A2
pathway of platelet activation but at the same time also the generation of
vasodilating and platelet-inhibitory prostanoids, such as prostacyclin, by
the endothelial cells. Ridogrel, by inhibiting thromboxane A2 synthase and
blocking the thromboxane A2/prostaglandin endoperoxide receptors, is a more
potent antiplatelet agent than aspirin and might offer an advantage over
aspirin as an adjunct to thrombolysis. This study was performed to compare
the efficacy and safety of ridogrel with that of aspirin as conjunctive
therapy for thrombolysis in patients with acute myocardial infarction.
METHODS AND RESULTS: A total of 907 patients with acute myocardial
infarction were randomized between aspirin and ridogrel given in addition
to streptokinase (1.5 MU over a period of 1 hour). The primary end point
was coronary patency (TIMI flow grades 2 and 3) at predischarge angiography
to be performed between 7 and 14 days after admission. A patent
infarct-related vessel was found in similar proportions of patients in the
two treatment groups: 72.2% in the ridogrel and 75.5% in the aspirin group.
The presence of clinical markers of reperfusion at 2 hours and the
incidence of major clinical events during hospital stay were also similar
in both groups. However, in a post hoc analysis, a lower incidence of new
ischemic events (reinfarction, recurrent angina, ischemic stroke) was
observed with ridogrel: 13% versus 19% in the aspirin group (a 32%
reduction; P < .025). No excess of serious bleeding complications,
including hemorrhagic stroke, was found. CONCLUSIONS: Ridogrel is not
superior to aspirin in enhancing the fibrinolytic efficacy of streptokinase
but might be more effective in preventing new ischemic events.
ARTICLES
Randomized trial of ridogrel, a combined thromboxane A2 synthase inhibitor and thromboxane A2/prostaglandin endoperoxide receptor antagonist, versus aspirin as adjunct to thrombolysis in patients with acute myocardial infarction. The Ridogrel Versus Aspirin Patency Trial (RAPT)
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