Evaluation The Effects Of Ticagrelor And Clopidogrel On The Function Of Platelet Aggregative By Using Flow Cytometry To Detect The Levels Of VASP Phosphorylation In Patients After PCI

BackgroundCoronary heart disease（CHD）is a common type of cardiovascular stenosis caused by atherosclerosis and a common disease that is critical to human health.Acute coronary syndrome（ACS）is a kind of clinical emergency in coronary heart disease（CHD）,and the main pathological mechanism basis is that unstable atherosclerotic plaque rupture or erosion leads to coronary artery thrombosis,and the platelet activation plays a very important role in the disease onset process.The antiplatelet aggregation drug is the main treatments for patients with ACS after percutaneous coronary intervention（PCI）,and studies have shown that platelet aggregation function is a independent risk factor of recurrent cardiovascular events in patients after PCI.The ways of detecting platelet function are different,there is no unified standard.MethodsWe enrolled 98 patients complication with ACS who were hospitalized and underwent PCI in the first affiliated hospital of zhengzhou university cardiovascular internal medicine form January 2015 to December 2015 and divided into ticagrelor group（n=50）and clopidogrel group（n=48）by random number table.Two groups were orally administrated with loading dose aspirin 300 mg at the first time,then 100 mg daily dose;and Ticagrelor group was administrated with loading dose ticagrelor 180 mg at first time,then 90 mg twice daily;the clopidogrel group was administrated with loading dose clopidogrel 300 mg at first time,then 75 mg daily dose.The VASP phosphorylation levels of two groups were detected before the treatment of drugs and 24h、7d、1month after PCI by flow cytometric（FCM）,and calculated the platelet reactivity index（PRI）and recorded major adverse events（MACE）and bleeding events within 1 month,then statistical analysis.ResultsThe baseline data of ticagrelor and clopidogrel groups were not significantly different（P>0.05）;vascular lesion and involvement of ticagrelor and clopidogrel groups were not significantly different（P>0.05）;The total number of PRI in the ticagrelor group and the clopidogrel group was compared at the same time point: there was no significant difference between the two groups before treatment（73.16 ± 13.25 vs 75.73 ± 12.32,P>0.05）;the mean levels PRI of ticagrelor group were significantly lower than clopidogrel groups after PCI 24 h 、 7d 、 1month(24.23±13.14 、 23.96±12.90 、 22.58±13.14 vs 56.25±13.15 、 54.61±12.62 、53.56±11.09,all P<0.001;Overall comparison: The total mean level of PRI were significantly difference within two groups at different time points(F_time=894.2,P<0.01);The total mean level of PRI were significantly difference between two groups(F_groups=103.9,P<0.01);Time and group had interaction effect(F_interaction=147.6,P<0.01).The percentage PRI≥ 50% of ticagrelor group were significantly lower than the clopidogrel group among different times after PCI（8.0%、4.0%、4.0% vs 75.0%、64.6%、60.4%,P<0.001）.The incidence of MACE and bleeding events were not significantly different within 1 month in two groups（0 vs 8.3%、14.0% vs 6.2%,P≥0.05）.Conclusion1.The anti-platelet aggregation of Ticagrelor inhibition was stronger and faster than clopidogrel.2.Ticagrelor reduced the ischemic cardiovascular events effectively after PCI recurrence by the function anti-platelet aggregation.3.ticagrelor didn’t increase the risk of bleeding in a short time,Compared with clopidogrel.