Retrospective Study On The Efficacy And Safety Of Ticagrelor And Clopidogrel In Patients After Coronary Artery Bypass Grafting

Objective :To compare the clinical efficacy and safety of Ticagrelor and Clopidogrel after the coronary artery bypass graft,and provide a better strategy of antiplatelet therapy.Method:From July 2014 to July 2016,a total of 260 patients that underwent coronary artery bypass grafting in our hospital were selected.According to the table of random numbers,these selected patients were divided into two groups,Ticagrelor group and Clopidogrel group randomly.These data were collected and compared with each other group that included basic information such as gender,age,age>75years old,weight,height;risk factors of cardiovascular disease which included smoking,mellitus diabetes,and previous history including myocardial infarction,per-cutaneous coronary intervention and heart failure.Meanwhile,we collected and compared the relevant information of coronary artery bypass grafting,such as the time of CABG,the approach to finish CABG,the time of cardiopulmonary bypass,the number of grafts and so on.The incidence of major adverse cardiovascular events in 12 months after CABG and safety related events like bleeding and dyspnea were followed up.The Peasron’s chi-squared test was used to compare frequencies.Continuous variables were expressed as median±standard deviation,and they were compared by using the Student’s t test.A P-value of <0.05 was defined as statistically significant.The data were analyzed by using SPSS 24.0.Results:In this study,241 patients finished the follow-up plan one year later.122 in Ticagrelor group and 119 in Clopidogrel group.The reason that didn’t finish the follow up in Ticagrelor group included 1 of death and 6 of drug and visit withdrawal while 3 of death and 9 of drug and visit withdrawal in the other group.The difference has no statistical significance between two groups(P >0.05)in gender,age,age>75 years old,weight,height,BMI of male,risk factors and previous history.However,the BMI of female in two groups was found to have a significant difference(P <0.05).In the aspect of the adverse events which were related with efficacy,there were 10 cases(8.2%)in Ticagrelor group and 19 cases(16.0%)in Clopidogrel group.One patient in Ticagrelor group died of small cell lung cancer,and there was no death in Clopidogrel group.There were 8 cases of recurrent angina pectoris in both groups,the incidence of angina was 6.6% and 6.7% respectively,meanwhile the angina symptom of Clopidogrel group was more serious than that of Ticagrelor group.In Clopidogrel group,there were 3 patients(2.5%)with recurrent myocardial infarction,2 of whom were re-admitted to receive PCI operation and 1 stent were implanted respectively,the third patient was improved after drug treatment.None of the patients in Ticagrelor group had these two kinds of events.For these events,the difference between two groups was not statistically significant.(P>0.05).In TG,one patient came back to hospital again because of heart failure,and six cases in CG.The difference had statistical significance.(P<0.05).In the safety related adverse events aspect,there were 27 cases in TG and 17 cases in CG.There were 19 cases of dyspnea in TG,most of which were mild and were unnecessary to be treated specially.In Clopidogrel group,11 patients had dyspnea symptoms,3 of them showed severe symptoms,and cured finally.The bleeding events in the two groups occurred in 6 cases(5.0%)and 8 cases(6.7%)respectively.Most of them showed subcutaneous bleeding,gingival bleeding and nasal bleeding which were not necessary to receive medical intervention.The difference had no statistical significant between the two groups(P>0.05).Conclusion:1.The efficacy of Ticagrelor combined with aspirin in patients undergoing coronary artery bypass grafting is not significantly different from that of Clopidogrel combined with aspirin;2.In the field of safety,there was no significant difference between the two drugs;3.The efficacy and safety of the Ticagrelor’s application on patients after coronary artery bypass grafting are not different than that of Clopidogrel.It reveals that Ticagrelor could be used as the antiplatelet strategy after coronary artery bypass grafting.