Effects Of Ticagrelor On Post PCI Patients With Clopidogrel Intermediate Metabolic Type

Objective Antiplatelet therapy is a cornerstone of coronary heart disease,and one of the important drugs currently in antiplatelet therapy is clopidogrel.Study found that 4%?31%of the patients have clopidogrel resistance.And the reason of clopidogrel resistance is numerous.It has confirmed that clopidogrel resistance is associated with clopidogrel metabolism types related genes polymorphisms.In The U.S.Food and Drug Administration(FDA)guide line of antiplatelet therapy,doctors advice to use these drugs before detecting CYP2C19 genotype of clopidogrel in patients with metabolic ability.For those the weak clopidogrel metabolism can choose the other antiplatelet drugs,such as ticagrelor,prasugrel ect.The Prasugrel has not yet officially listed in our country,and ticagrelor is not included in the medical insurance.Its relatively expensive price leads to clinical practice still with clopidogrel as the preferred P2Y12 receptor inhibitor.Genetic testing for patients with slow clopidogrel metabolism,it is a broad consensus suggested to switch to ticagrelor therapy.But whether intermediate metabolism in those patients turned to ticagrelor better is unknown.This study discusses the effects of ticagrelor on post PCI with intermediate metabolic type of clopidogrel.Methods The study selected 97 cases of Coronary Heart Disease and treated in the First Hospital of Dalian Medical University from December 2015 to September 2016.For diagnosis of therapy post PCI,all patients were routinely offered aspirin(300mg/100mg qd)and clopidogrel(300mg/75mg qd)as conventional dual antiplatelet medication.The CYP2C19 gene polymorphism is conventionally tested.The CYP2C19 gene polymorphism tip results in clopidogrel intermediate metabolic type,and it adopts by random table method.Patients were randomly divided into continue to conventional dual antiplatelet drug therapy(group A)and switch to ticagrelor 90 mg twice daily + 100 mg once daily oral aspirin therapy(group B).The patients were monitored for platelet aggregation rate and were followed for 3 months after discharge.Statistical analysis of group A and group B platelet aggregation and the MACE events were recorded.Results The results showed that the maximum aggregation rate of platelets in group A and group B were statistically significant.The group B had a lower platelet aggregation rate,which indicated that the inhibition of platelet inhibition was an evident in the metabolic rate.MACE of postoperative coronary heart disease(CHD)patients after 3 months follow-up,results indicated no statistical difference between the 2 groups above.The reason may be that ticagrelor and clopidogrel were continuously used in those patients in the intermediate metabolism type of clopidogrel.Conclusion The effect of ticagrelor on inhibitting platelet function in patients with intermediate metabolic was more effect.Ticagrelor did not bring more immediate clinical benefit to the patient in intermediate metabolism type of clopidogrel.