Efficacy And Safety Evaluation Of Ticagrelor In Patients With Acute Coronary Syndrome

Background:Clopidogrel, as a drug for dual antiplatelet therapy to acute coronary syndrome(ACS), is currently the most commonly used clinical P2Y12 receptor inhibi-tor. Although standardized therapy with Clopidogrel in combination with aspirin sign-ificantly reduced the incidence of adverse cardiovascular events rate, this treatment still failed to achieve the desired effect in some patients, i.e., drug resistance. Ticagrel-or cyclopentyl triazole pyrimidine is the first oral anti-platelet drug, which is selectiv-e,reversible P2Y12 receptor inhibitor. It is a potent platelet aggregation inhibitor, and has been recommended by treatment guide all over the world. Even though there are some relevant clinical studies, due to the regional variations, sample volume, and the different research methods, the results are currently inconsistent. Furthermore, apply ing P2Y12 receptor inhibitor to patients should not only carefully consider the benefit-s, but also the adverse reactions and side effects of the drugs.Objective:Evaluate the efficacy and safety of P2Y12 receptor inhibitor ticagrelor and clopidogrel treatment for ACS patients that undergone percutaneous coronary intervention(PCI), through comparing the degree of inhibition of platelet aggregation, the adverse cardiovascular events and other adverse reactions.Method:This is a prospective study. In the the First People’s Hospital of Chuzhou City,101 patients with ACS that undergone PCI from March 2013 to March 2014, were randomized allocated into experimental(53 cases) and control(48 cases) groups. Both groups received oral P2Y12 receptor inhibitor and aspirin(loading dose 300 mg, and the maintenance dose 100 mg, 1 time / day), the control group received clopidogrel(loading dose of 300 mg and maintenance dose of 75 mg, 1 time / day),and the experimental group received ticagrelor(loading dose 180 mg and maintenance dose of 90 mg, 2 times / day). Platelet aggregation rate,blood,liver and kidney function and B- type natriuretic peptide was measured before treatment and 1 week after maintenance therapy, and all the patients were followed-up for 3 months to compare the incidence of adverse cardiovascular events and other adverse reactions between the control and the experimental groups.The degree of inhibition of platelet aggregation were measured by light transmission aggregometry and 5 u mol / L of adenosine diphosphate as platelet aggregation inducer.Result:1.In this study, 101 cases of acute coronary syndrome were selected as subjects,74 cases were male(73.3%), with an average age of 64.43 ± 10.85 years old,general information is not significant different between the control and the experimental groups(P>0.05).2.After load dose antiplatelet therapy one week, for the control and the experimental groups, the maximum platelet aggregation rates were 36.50 ± 10.59 vs 32.45 ± 9.05, respectively, P= 0.020;Aggregation inhibition rates were 24.54 ± 9.82vs28.97 ± 6.79, respectively,P = 0.002;ΔA <10% of the patients were 11(20.75%) vs3(6.25%), respectively,P = 0.035;Post-PA> 46% of patients were 13(24.52%) vs4(8.33%), respectively,P = 0.030.3.After load dose antiplatelet therapy one week, the concentrations of blood uric acid and B- type natriuretic peptide were statistically significant different between the control and experimental groups; specifically, the blood uric acid is higher in experimental group(337.48±99.57vs283.51±95.60,P=0.007), while the B- type natriuretic peptide is lower(61.63±36.27vs95.45±64.04,P=0.001). In contrast, there were no significant differences between two groups for the aminotransferase and creatinine values.4.Found in the liver and kidney function and BNP comparative study before and after treatment,The alanine aminotransferase, uric acid and creatinine values of the control group were no difference between the before and after treatment,but the BNP is lower in after treatment than before treatment(95.45±64.04v171.51±142.95,P=0.001);No dif-ference between the before treatment and after treatment in alanine aminotransferase and creatinine of the experimental group,but the blood uric acid is higher in after treat-ment than before treatment(337.48±99.57vs282.83±132.55,P=0.025),BNP is lower in after treatment than before treatment(61.63±36.27vs144.29±117.27,P=0.000)in experi-mental group.5.The incidence of the adverse cardiovascular event and adverse reactions were quantified through subsequent following up:The incidence of adverse cardiovascular events in the control group is higher16.98%v4.17%,P= 0.039,But there was no difference in adverse reactions between two groups(P=0.599).There is no difference in the subgroups of cardiovascular adverse events(cardiac death,myocardial infarction, recurrent angina and heart failure).The differences in bleeding of adverse reactions subgroup between control group and experimental group(1.89%vs14.58%,P =0.047),but no difference in terms of severe bleeding(P = 0.475),two groups were no-t found to have fatal bleeding.Cases of patients dyspnea were found in the experimen-tal group,other outcome measures did not find statistically significant differences,Dru-g resistance is a risk factor for adverse cardiovascular events in the Cox regression analysis(β=1.735,RR=5.655,P=0.007),Kaplan-Meier analysis showed that the use of ticagrelor compared clopidogrel significantly decreased incidence of adverse cardiovascular events, but have risk of bleeding(P<0.05).Conclusions : 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;The two drugs were not found to affect liver function,and no significant change in serum creatinine,but ticagrelor can increase blood uric acid;In improving cardiac function ticagrelor than clopidogrel;Although dyspnea adverse reactions for the difference not statistically,However, there was no observation of clopidogrel dyspnea occurred.