The Safety And Feasibility Of Different Doses Of Ticagrelor In Patients With Non-st-segment Elevation Acute Coronary Syndrome After Interventional Therapy

Objective: To compare the safety and effectiveness of adjusting the dose of ticagrelor based on platelet aggregation rate in patients with non-ST-segment elevation acute coronary syndrome after interventional therapy.Methods: Continuous admission was taken from patients who were diagnosed with NSTE-ACS and PCI in the 5th Department of Cardiology of the Second Hospital of Hebei Medical University from September 2019 to August 2020.All patients were given a loading dose of aspirin(300 mg)and loading dose of ticagrelor(180mg)after admission,followed by maintenance dose of aspirin(100mg,1 time/day)combined with standard dose of ticagrelor(90mg,2 times/day)treatment.Patients with platelet aggregation rate ≤25%on day 5-7 after admission were randomly divided into three groups: A,B,and C.All the patients in three groups were given aspirin 100 mg once a day.Patients in group A were given ticagrelor 45 mg twice a day.Patients in group B were given ticagrelor 60 mg twice a day and patients in group C were given ticagrelor 90 mg twice a day.Observation endpoints: 1.The level of platelet aggregation rate among the three groups: at admission,5-7 days after admission,1 month after discharge,3 months after discharge,6 months after discharge.2.The occurrence of major adverse cardiovascular events(MACE)within 6 months of discharge: including all-cause death,angina pectoris re-admission,myocardial infarction re-admission,heart failure re-admission.3.Ticagrelor related adverse events: bleeding events(bleeding academic research consortium(BARC)type 1-5),dyspnea,arrhythmia.Results: In terms of platelet aggregation rate(PAR),there was no statistical difference in the PAR of the three groups at admission,5-7 days after admission.However,after treatment and follow-up,it was found that group A was higher than that of group B and C in the PAR level after discharged for 2 weeks,1 month,3 months,and 6months.The difference in PAR between 6 months after discharge and grouping of group A was higher than that of group B and C(P <0.01).The difference in PAR between 6 months after discharge and grouping of group B was higher than that of group C(P<0.01).There was no statistical difference in MACE(all-cause death,angina pectoris re-admission,myocardial infarction re-admission,heart failure re-admission)occurred within 6 months of discharge,bleeding events and dyspnea(all P>0.05).Conclusion:1.The use of ticagrelor 45 mg and 60 mg has a dose-related response compared with 90 mg ticagrelor for NSTE-ACS patients after PCI.2.Decreasing the dose of ticagrelor according to the platelet aggregation rate is safe and effective,and does not increase the occurrence of ischemia and bleeding.