Efficacy And Safety Of Ticagrelor In Patients With Acute Coronary Syndrome

BackgroundThe sudden rupture of coronary atherosclerotic plaque leads to platelet activation and aggregation,further promotes the formation of acute thrombosis,finally causes the clinical syndrome of acute myocardial ischemia.Dual antiplatelet of the combination of aspirin and a P2Y12 receptor inhibitor is the cornerstone of antiplatelet therapy of patients with acute coronary syndromes(ACS).The PLATO trial is a large,randomized,international multicenter study which revealed that novel P2Y12 receptor inhibitor ticagrelor has a faster and more consistent inhibitory effect of platelet aggregation than clopidogrel.However only a small number of the patients in this study is Chinese,so it is quite necessary to conduct a clinical research to evaluate the efficacy and safety of ticagrelor.ObjectiveTo explore the clinical efficacy and safety of ticagrelor in Chinese patients with ACS in order to provide clinical reference of ticagrelor for Chinese.Methods154 patients admitted to Department of Cardiology,coronary care unit of Zhengzhou People's Hospital with ACS from March 1,2014 to September 30,2014 were selected and randomly divided into ticagrelor group(80 cases)and clopidogrel group(74 cases)using digital table method.Coronary angiography(CAG)was performed in all patients,before CAG two groups were given aspirin loading dose 300 mg and maintenance dose 100 mg daily,ticagrelor group was given ticagrelor loading dose 180 mg and maintenance dose 90 mg twice daily,clopidogrel group was given clopidogrel loading dose 600 mg and maintenance dose 75 mg daily,other treatment methods(statins,beta blockers,angiotensin converting enzyme inhibitor/angiotensin II receptor blockers,low molecular weight heparin,and so on)based on the conventional treatment of ACS.The efficacy endpoint and safety endpoint were followed prospectively for 12 months.The efficacy endpoint consisted of primary endpoint(cardiovascular death,myocardial infarction or stroke)and secondary endpoint(all-cause death,target vascular reconstruction,stent thrombosis,hospitalized for heart reason,transient ischemic attack).The safety endpoint consisted of bleeding and dyspnea.Prothrombin time(PT),activated partial prothrombin time(APTT),fibrinogen(FIB),low density lipoprotein cholesterol(LDL-C),high density lipoprotein cholesterol(HDL-C),alanine aminotransferase(ALT),aspartate aminotransferase(AST),direct bilirubin(DBIL),uric acid(UA),creatinine(Cr)and platelet count(PLT)were compared before and after treatment between two groups.ResultsThere was no significant difference in baseline and ACS type,clinical medication(not including P2Y12 receptor inhibitors),CAG and treatment between the two groups.The composite of ischemic(all-cause death,target vascular reconstruction,stent thrombosis,hospitalized for heart reason,transient ischemic attack,bleeding,dyspnea)in ticagrelor group was lower compared with clopidogrel group in the next month-12 follow up(p<0.05).There was no difference in the primary endpoint and major bleeding between two groups.However,the incidence of total bleeding and dyspnea in ticagrelor group were significantly higher than those in clopidogrel group,but did not cause the interruption of treatment.After six weeks of treatment,the direct bilirubin(DBIL)and blood uric acid(UA)were significantly higher in ticagrelor group than those in the clopidogrel group(p <0.05),but all within the normal range and did not result in adverse clinical consequences,and there were no clinical significance.ConclusionsCompared with clopidogrel,ticagrelor can more effectively reduce the risk of composite of ischemic events of all-cause death,target vessel revascularization,stent thrombosis,hospitalized for heart reason,transient ischemic attack in patients with ACS.Ticagrelor did not increase the risk of major bleeding,the adverse reactions were mild and the advantages far outweighed the disadvantages.