Ticagrelor And Clopidogrel In Acute Coronary Syndromepatients With Antiplatelet Effect Comparison

Objective:This study aimed to investigate the platelet function of ticagrelor and clopidogrel in patients with acute coronary syndrome during the period of hospitalization as well as to observe efficacy and security.Method:In this randomized trail,we compared ticagreor(180mg loading dose,90 mg twice daily thereafter)and clopidogrel(600mg loading dose,75 mg daily thereafter) for the difference of platelet aggregation,the prevention of cardiovascular events in 120 Patients with ACS.The total duration of the study was hospitalization time. Patients were treated with conventional therapy and low salt low fat diet. Samples for platelet function testing were taken at predosing(0hour)and after the first dose of study drug on 0.5hour,2hour,24 hour and 5th day. Anytime point of the platelet aggregation was compared. We adjudicated all suspected efficacy end points as well as major and minor bleeding events.Results:1 The maximum platelet aggregation rate at baseline had no difference between ticagrelor and clopidogrel(52.2 ± 13.3% VS 48.9 ± 13.1%,P=0.18).The average aggregation rate at baseline had no difference between ticagrelor and clopidogrel(46.4±13.3% VS 43.3±13.9%,P=0.219).The maximum platelet aggregation rate at 0.5h in the ticagrelor group was significantly lower than that in the clopidogrel group(30.4±11.7%VS 49.6±14.0%,P=0.00).The average platelet aggregation rate at 0.5h in the ticagrelor group was significantly lower than that in the clopidogrel group(27.3±11.2% VS 43.3±14.8%,P=0.00).The maximum platelet aggregation rate at 2h in the ticagrelor group was significantly lower than that in the clopidogrel group( 24.7 ± 8.4% VS39.2 ±13.1%,P=0.00).The average platelet aggregation rate at 2h in the ticagrelor group wassignificantly lower than that in the clopidogrel group( 20.3 ± 7.4% VS 33.5 ±12.7%,P=0.00).The maximum platelet aggregation rate at 24 h in the ticagrelor group was significantly lower than that in the clopidogrel group( 26.1 ± 7.7% VS 38.6 ±12.8%,P=0.00).The average platelet aggregation rate at 24 h in the ticagrelor group was significantly lower than that in the clopidogrel group(22.1±7.6% VS 33.6±12.5%,P=0.00).The maximum platelet aggregation rate at 5thd in the ticagrelor group was significantly lower than that in the clopidogrel group( 31.5 ± 9.1% VS 40.6 ±12.2%,P=0.00).The average platelet aggregation rate at 5thd in the ticagrelor group was significantly lower than that in the clopidogrel group(27.9±8.8 VS 34.6±12.8,P=0.00).2. MACE events between the two groups had no difference( 1.7% VS1.7%,P=1.000).The other events between the clopidogrel and ticagrelor had no difference(36.7% VS 35.0%, P=0.84).3 None patient of two groups had massive hemorrhage(0% VS 0%,P=1.000);None patient in clopidogrel had small hemorrhage,2 patients in ticagrelor had small hemorrhage( 0% VS 3.3%, P=0.476); Minor bleeding in clopidogrel group was significantly less than in ticagrelor group(25% VS 43.3%,P=0.034).There were no obvious damage to liver or kidney function in two groups.Conclusion:1.Ticagrelor 180 mg could inhibit platelet aggregation quickly in 0.5h,and achieved the maximum inhibition in 2h.Clopidogrel 600 mg could not achieved inhition of platelet aggregation in 0.5h.2.MACE and other adverse events were no difference between ticagrelor and clopidogrel in short time(5~7d).3.Incidence of minor bleeding was higher in ticagrelor group.