Efficacy And Pharmacoeconomic Analysis For TAIJIA And PLAVIX In Percutaneous Coronary Intervention

Background and ObjectivesWith the rapid progress of percutaneous coronary intervention (PCI), the drug-eluting stents are widely used. The balloon causes mechanical damage to the intimal of coronary artery. This may expose the collagen under the intimal to platelets to activate them, which brings out about a rate of 3%～5% of coronary occlusion after PCI. The anti-cell cycle drugs coated on the surface of stents inhibits the proliferation of endothelial cells. It may result in extension of the stent endothelialization process, and acute, subacute, late and very late stent thromboses are more likely to form. Therefore adequate antiplatelet therapy preoperative and postoperative is essential. Clopidogrel combined with aspirin is the standard anti-platelet therapy before and after PCI. Currently, there are two clopidogrel listed in China:one is domestic, named TAIJIA, the other is imported, named PLAVIX. But there is no systematic study on domestic and imported clopidogrel used in PCI. This article is to discuss the clinical efficacy and the changes caused by platelet activation of domestic and imported clopidogrel used in PCI, and perform pharmacoeconomic analysis in order to provide doctors and patients with experimental basis when they select drugs.Materials and Methods1 Patients:107 hospitalized cases diagnosed as acute coronary syndrome having received percutaneous coronary intervention during the period from March,2008 to March,2010 were selected. Exclusion criteria:①Those who are allergic to aspirin or clopidogrel;②Those who have received treatment of coronary revascularization (including PCI and coronary artery bypass grafting) during the past 6 months;③Those with cardiogenic shock;④Those who have obvious bleeding tendencies;⑤Those who have serious liver and kidney dysfunction or blood disorders and can not tolerate long-term aspirin, clopidogrel, statin therapy;⑥Those who have recently suffered from severe hemorrhagic diseases, such as a history of cerebral bleeding;⑦Those who have malignancy;⑧Those whose pathological changes are serious and choose coronary artery bypass grafting surgery.2 Methods:All patients were randomly divided into 2 groups, TAIJIA group and PLAVIX group. Each patient was given 300mg TAIJIA or Plavix when admitted to hospital. Those who were receiving emergency surgery were given 600mg TAIJIA or Plavix.75mg TAIJIA or Plavix per day was given on following days till a year after percutaneous coronary intervention. The other treatments are all the same.3 Outcome Measures:3.1 Major adverse cardiovascular events during hospital days and a year after percutaneous coronary intervention. Major adverse cardiac events(MACE) includes re-infarction, ventricular fibrillation, atrial fibrillation, heart failure, recurrent angina, cardiac death, revascularization, etc.3.2 Adverse reactions:rash, abdominal discomfort, thrombocytopenia, abnormal taste, blood in the stool, liver dysfunction and kidney dysfunction, etc.3.3 Blood routine test:Blood routine test was tested Before PCI and 1 week,12 weeks after PCI so as to understand the changes of platelet, granulocyte.3.4 Coagulation function test:Coagulation function test was tested on the day before surgery and a day, a week, three months after PCI, to approach the changes of prothrombin time (PT) and activated partial thromboplastin time (APTT).3.5 The changes of thromboxane B2 (TXB2) in the blood.3.6 Cost:The price of domestic and imported clopidogrel was investigated by taking into account the cost of the therapy for adverse reactions and major adverse cardiac events. Minimum cost accounting analysis was performed. 4 Statistical analysis:Using SPSS 11.5. for statistical analysis.Results1 Comparison of clinical data of the two groups:There was no significant difference.2 Hematology index:There was no significant difference between the 2 groups at platelet count, granulocyte count, PT, APTT, TXB2 amount and the changes before and after percutaneous coronary intervention, P>0.05.3 Comparison of treatment outcome:There was no significant difference at the treatment effects, adverse reactions between the two groups of patients.4 Comparison of the total cost of treatment:The cost of TAIJIA group averaged 4959.93 yuan per person, while the PLAVIX group was 7983.36 yuan per person. The cost of TAIJIA group was significantly lower than PLAVIX group, P< 0.001.Conclusions1 The treatment efficacy of TAIJIA and PLAVIX were the same.2 The cost of TAIJIA group was significantly lower than PLAVIX group.