| Objective: With the improvement of living standards,the incidence of acute coronary syndrome(ACS) increased in the population with high blood pressure, hyperlipidemia, diabetes.The ACS is the critical patients of coronary heart disease, with high mortality.Currently, percutaneous coronary intervention(PCI) is the most effective solution to cure ACS.In spite of updating Scaffold material and improving operation technology, there are still a part of post-PCI patients with stent thrombosis, recurrence of angina pectoris, myocardial infarction and other cardiovascular adverse events.Therefore, effective antithrombotic therapy is the guarantee of patients with good prognosis.With the emergence of new antiplatelet agents, the classic antiplatelet treatment status of aspirin and clopidogrel was challenged continually.As a new antiplatelet agents, ticagrelor is growing concern about rapid onset, strong function and low incidence of drug resistance.By contrast, clopidogrel with slow onset, the bad recovery of platelet function after the drug stop, is prone to interact with other medications,and is high susceptible to individual differences of gene polymorphism and platelet reactivity. Therefore, the rate of clopidogrel resistance is higher, around 4.2% ~ 31%.International multicenter clinical research(PLATO) confirmed that ticagrelor as a new type drug with stronger antithrombotic effect, significantly reduced the cardiovascular mortality and improved the prognosis of patients.At the same time,ticagrelor did not increase the risk of bleeding.However,the patients with clopidogrel resistance was not excluded in the PLATO study.It is unclear that whether applying ticagrelor after PCI still improve the prognosis of patients with non-clopidogrel resistance.In spite of fast onset and strong function, ticagrelor had a high incidence of shortness of breath, as well as a heavy burden on the economy.Some patients could not stick to take medicines due to severe shortness of breath or economic reasons.How to switch into clopidogrel for patients with applying ticagrelor has not been reported.The purpose of research is to evaluate short-term clinical curative effect of ticagrelor for post-PCI patients who response well to clopidogrel by TEG results.At the same tine, we need to clear whether giving loading clopidogrel of switching drugs to ticagrelor patients is appropriate.We hope to provide the best antithrombotic therapy for PCI patients.Methods:1 Included the study subjectsSelected the ACS patients 380 cases without clopidogrel resistance after susscessful PCI in the second hospital east campus of Hebei Medical University during the period of December in 2013 to August in 2015.The subjects included(380 cases)were randomly divided into clopidogrel group(190 cases) and ticagrelor group(190cases) according to randomization. All selected objects had been given oral aspirin(300 mg)and clopidogrel(300 mg)before PCI.The clopidogrel group continued to be applied to oral clopidogrel 75 mg QD after PCI,and the ticagrelor group was switiched to oral ticagrelor 90 mg bid. The ticagrelor group was classified as three subgroups after 3-month treatment, the subgroup 1 and subgroup 2 were switched to oral clopidogrel.The subjects of subgroup 1 maintain to oral 75 mg QD after 300 mg load clopidogrel;The subgroup 2 patients were applied to clopidogrel 75 mg QD,and the subgroup 3 patients continued to apply for ticagrelor 90 mg BID.2 The laboratory and clinical observation indexAdopt the preoperative basic data and laboratory data of selected objects proceed statistics analysis,and monitor the TEG results of post-PCI 3 months to compare ADP inhibition rate and MAADP of ticagrelor to clopidogrel. Then to proceed statistical analysis of adverse cardiovascular events,bleeding events and the incidence of adverse drug reactions.Monitoring TEG results of the subgroups subjects after switching to clopidogrel 3-month,and to analyze MAADP value, ADP inhibition rate and adverse cardiovascular events. 3 statistical data analysisStatistical analysis was performed by SPSS 21.0. The measurement data was tested to conform to normality and equality of variance.The measurement data conformed to normality and equality of variance were presented as mean ± standard deviation,and were applied to the single factor analysis of variance;The others were presented as Median ±QR,and were applied to rank sum test. The count information were applied to cases or percentage, using chi-square test. Statistically significance was defined as P <0.05.Result: 1 There were no significant differences beween clopidogrel and ticagrelor in clinical basic data such as general situation, medical history, the number of coronary vascular lesions and drug therapy(P >0.05). 2 Comparion of curative effect after post-PCI 3 months in two groups 2.1 According to TEG results,the ADP inhibition rate in the ticagrelor group was obviously higher than that in the clopidogrel group(71.50±12.27 vs. 59.77±15.46, P < 0.05),showing a statistically significant difference;The MAADP value in the ADP pathway was obviously lower than that in the clopidogrel group(28.76 ±8.99 vs36.82 ± 10.91, P < 0.05),showing a statistically significant difference. 2.2 The incidence of MACE events in the ticagrelor group was obviously lower than that in the clopidogrel group after PCI 3 months(1.05% vs 4.74%, P < 0.05), the difference showed statistically significance;There was no significant difference in the major bleeding, secondary bleeding between ticagrelor and clopidogrel group( 1.05% vs 0.53%, 1.58% vs 1.05%,P>0.05).However,the incidence of slight bleeding in ticagrelor group was obviously higher than that in clopidogrel group(16.32% vs 5.26%,P<0.05).The rate of dyspnea in ticagrelor group was obviously higher than that in clopidogrel group(15.34% vs 0.53 %, P < 0.05), showing a statistically significant difference.Gout, arrhythmia, liver and kidney function damage and other adverse drug reactions were not found in two groups. 3 Comparion of curative effect after post-PCI 6 months in the subgroups of ticagrelor 3.1 No statistically significance difference of ADP inhibition rate was found in the subgroup 1 and subgroup 2(60.77±19.79 vs 61.42±16.64, P > 0.05), and the MAADP value under the ADP way was found no statistical difference(36.54±10.42 vs 39.01±11.24, P > 0.05); There were significant differences in the ADP inhibition rate in the subgroup 1 and 3,subgroup 2and 3(60.77±19.79 vs 71.02±12.83, 61.42±16.64 vs 71.02 ±12.83, P < 0.05), showing a statistically significant difference; The MAADP value had obvious differences in the subgroup 1 and 3, subgroup 2and 3(36.54±10.42 vs 29.31 ±8.30, 39.01±11.24 vs 29.31±8.30, P < 0.05), the result showed statistically significant. 3.2 No statistically significance difference was found after post-PCI 6-month in cardiovascular adverse events,bleeding events(primary, secondary, minor bleeding), adverse drug reactions(dyspnea, gout, arrhythmia, liver and kidney impairment, etc.)between the subgroups(P > 0.05);Conclusion:1 The antiplatelet effect of ticagrelor application after PCI was obviously stronger than clopidogrel application in patients which responsed well to clopidogrel,the incidence of adverse cardiovascular events was decreased; Ticagrelor application increased the risk of minor bleeding, but it was found no difference between the major bleeding, secondary bleeding;A greater dyspnea incidence was found in patients ticagrelor application,compared to clopidogrel.Most of dyspnea subjects can tolerated, and alleviated automatically, which didn't affect the end.2 The load and maintain dosage when switching ticagrelor to clopidogrel were found no obvious difference in antiplatelet effects,cardiovascular adverse events,and bleeding events. |
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