Applying Thrombelastogram To Evaluate Platelet Inhibitory Effect And Clinical Efficacy Of Ticagrelor Versus Clopidogrel For Patients After PCI

Objective Applying thrombelastogram to evaluate the platelet inhibitory effect of ticagrelor and clopidogrel on patients after PCI, comparing the clinical efficiency by means of follow-up visit.Method From December 2013 to October 2014, a totally 96 patients who were diagnosed acute coronary syndrome and before undergoing PCI in Tangshan Gongren Hospital affiliated to North C hina University of Science and Technology was enrolled in our study. There were 77 men and 19 women, mean age 58.3±10.98 years. We divided them into ticagrelor group and clopidogrel group randomly. There were 40 men and 7 women enrolled in ticagrelor group(mean age 57.64±11.32 years), while 37 men and 12 women in clopidogrel group(mean age 58.94±10.73 years). Patients in ticagrelor group took full dose of aspirin 300 mg and ticagrelor 180 mg orally before PCI, then aspirin 100 mg qd and ticagrelor 90 mg bid after PCI to anti-patelet aggregation. While full dose of aspirin 300 mg and clopidogrel 300 mg was taken orally before PCI, then aspirin 100 mg and clopidogrel 75 mg qd after PCI in clopidogrel group. The blood samples were collected in 24 hours and 1 month after PCI, using CFMST M thrombelastogram instrument to detecting platelet inhibition ratio through ADP approach, then stratified the record to comparing the effect of anti-platelet between the two drugs. In addition, the follow-up was done in the duration of hospital stay and 1 month after PCI, comparing the occurrence of MACE and bleeding events to evaluate the clinical efficiency of the two drugs.Result 1 From the detection of thrombelastogram, the platelet inhibition ratio in ticagrelor group was higher than clopidogrel group in 24 h and 1 month after PCI respectively(84.1±16.5% vs. 68.9±27.9%, P<0.05 and 79.1±22.3% vs. 40.1±25.1%, P<0.05). Then we stratified the data according to the inhibitory effect, and found that the platelet inhibitory effect of ticagrelor was better than clopidogrel in 24 h and 1 month after PCI(P<0.05). 2 There was no significant difference in the occurrence of MACE during hospital stay in both groups(6.4% vs. 8.2%, χ2=0.112, P>0.05). However, we found a statistical difference of the occurrence of MACE in 1 month after PCI between two groups(2.8% vs. 30.6%, χ2=6.332, P=0.012). Ticagrelor can reduce the occurrenceof MAC E obviously compared with clopidogrel. 3 We found no statistical difference of the occurrence of bleeding events between two groups in the duration of hospital stay and 1 month after PCI, respectively(6.4% vs. 4.1%, χ2=0.257, P>0.05 and 4.3% vs. 8.2%, χ2=0.625, P>0.05). And we classified the bleeding events according to the TIMI classification standard to evaluate the severity of bleeding and found no difference between two groups(P>0.05).Conclusion Comparison of platelet inhibition effect and clinical efficacy of patients after PCI, ticagrelor is superior to clopidogrel, and does not increase the risk of bleeding or aggravate the severity of bleeding.