| Background Cardiovascular disease,including acute coronary syndrome(ACS),is a leading cause of morbidity and mortality worldwide.The multicenter global acute coronary event registration study(GRACE)shows that the mortality rate of ACS patients is about 15% after 1 years,which increased to about 25% after 3 years,and reached to about 4 years later.The pathophysiological mechanism of ACS is the platelet aggregation and adhesion on the basis of the rupture of coronary atherosclerotic plaque,and induced acute thrombosis leading to partial or complete occlusion of the coronary artery.Platelet activation plays an important role in the development and progression of acute coronary syndrome in patients with coronary heart disease(CHD).Percutaneous coronary intervention(PCI)is an important measure in the treatment of coronary heart disease;In patients with acute coronary syndrome(ACS),dual antiplatelet therapy with aspirin and clopidogrel has been the cornerstone strategy.The efficacy of clopidogrel is variable due to different transformation of the prodrug to active metabolite in different patients,andclopidogrel resistance,may increase the risk of adverse cardiovascular events,such as stent thrombosis and myocardial infarction.The polymorphisms of cytochrome P4502C19 might be one of the factors influencing the individual susceptibility.Ticagrelor is a reversible and direct-acting antagonist of the adenosine diphosphate receptor P2Y12,providing faster,and more consistent platelet inhibition than clopidogrel.Because ticagrelor does not need metabolic activation and has less interindividual ariation in drug action,is not a prodrug and acts directly on the P2Y12 receptors.It is a more potent antiplatelet drug in comparison with clopidogrel.At present,the United States,Europe and China’s current ACS management guidelines and percutaneous coronary intervention guidelines recommend ticagrelor as first-line antiplatelet drugs in patients with ACS.Objection In this study,we compared ticagrelor and clopidogrel for the platelet aggregation,inflammatory factors,cardiac function and major adverse cardiovascular events,bleeding events and related adverse drug reactions at differt times,and investigated the efficacy,safety and health-related quality of life of ticagrelor versus clopidogrel,to explore how to use the antiplatelet aggregation drugs in ACS patients with PCI.Methods ACS patients(n=221)who undergoing received PCI were chosen from Nov.2015 to May 2016.According to the random number generated by the computer,the patients were randomly divided into ticagrelor group(observation group)and clopidogrel group(control group).Those patients all receive the vasodilator,statins,beta blockers,angiotensin converting enzyme(ACEI)inhibitors or angiotensin II receptor antagonist(ARB)and subcutaneous injection of low molecular weight heparin and control risk factors for optimal treatment.Clopidogrel was administered at a 300 mg loading dose(LD)with an maintenance dose(MD)of 75 mg once daily.Ticagrelor was administered at a 180 mg LD,and then an MD of 90 mg twice daily.All patients took aspirin at an LD of 300 mg followed by an MD of 100 mg once daily,unless aspirin was intolerant.The course of treatment was required to continue for 12 months.The platelet aggregation rate,C-reactive protein(CRP),EF value,MACE rates,rates of bleeding events and other clinical adverse events at different time between the two groups were compared after twelve months of follow up.Results(1)Baseline characteristics,such as gender,age,basic disease,smoking history,family history,vascular disease,hemoglobin,blood lipid,serum creatinine,glycosylated hemoglobin level,and clinical diagnosis had no significant difference between patients taking ticagrelor.(2)There were no significant differences in basic ADP-induced platelet aggregation rate between the two groups(P>0.05).The ADP-induced aggregation rate of taking ticagrelor was significantly lower thanpatients taking clopidogrel.There were significant differences in ADP-induced platelet aggregation rate in ticagrelor groups(P<0.05).(3)Before treatment,CRP,vascular ultrasonic detection indexes with right brachial artery of two groups of patients,the difference was not statistically significant(P>0.05).There was obvious difference in C-reactive protein and FMD、Vm in the two groups after treatment,for the changes of ticagrelor group was significantly elevated.(4)Ticagrelor was more effective than clopidogrel in decreasing the primary efficacy end point(CV death,MI,and stroke,P<0.05).The all-cause mortality was not significantly different between patients taking ticagrelor and clopidogrel(P>0.05).Conclusions(1)The current study demonstrated that ticagrelor had the superior efficacy of inhibting of platelet aggregation to clopidogrel,this effect continue to play a role in the postoperative,and remain a stable state.(2)Ticagrelor may have an effect of the anti-inflammatory,and can regulate the inflammatory response,the mechanism is associated with increased ticagrelor plasma adenosine concentration in patients.(3)Ticagrelor in terms of inhibition of platelet aggregation,reduce cardiovascular adverse events is stronger than clopidogrel in the conventional therapeutic dose;the overall adverse reactions undifferentiated between ticagrelor and clopidogrel,in bleeding adverses,the overall incidence of ticagrelor is higher than clopidogrel,but moderate to severe bleeding is no difference between the two groups,especially fatal bleeding.(4)Ticagrelor were found to increase dyspnea adverse reactions,which there was no observation of clopidogrel dyspnea occurred.It may be concerned with adenosine,and these adverse reactions can be tolerated without serious clinical consequences.(5)Ticagrelor has stronger effect of antiplatelet aggregation and clinical pleiotropy,and it improved the quality of life of patients. |
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