Plateletworks Was Used To Compare The Antiplatelet Effects Of Different P2Y12 Receptor Antagonists

Background and purpose:The incidence of coronary atherosclerotic disease is getting higher and higher,the current study that the main mechanism of the disease is thrombosis,so anti-platelet is an important factor in the prevention of thrombosis.Currently used in the conventional double antiplatelet drugs,many patients due to clopidogrel resistance to drug response to poor or no response has led to the occurrence of a variety of adverse events,and the new P2Y12 receptor antagonist ticagrelor through large Clinical trials PLATO and other studies have found that compared with clopidogrel ticagrelor significantly reduce the risk of recurrence of thrombotic events,and does not increase the fatal bleeding events.However,the East Asian and European people have different characteristics of their own,in the double treatment of anti-platelet platelet hyperresponsiveness is higher,but the risk of ischemia is lower,the risk of bleeding is high,many guidelines from a applicable all patients gradually reflect the race-specific Sexual treatment.In the PLATO study,only 5.9%of the Asian population,and the recent publication of the PHILO(100%of the population into Asia)study more inclined to Tegeluo Luo in Asia did not find a more obvious advantage.In this context,how to choose the East Asian proper P2Y12 receptor antagonist has become a recent hot spot.We use of PL-11 monitoring of platelet aggregationfunction to evaluate the inhibition of clopidogrel and ticagrelor on platelets.Methods:A total of 377 patients with coronary heart disease who underwent PCI from January 2016 to October 2016 in the First Affiliated Hospital of Dalian Medical University were enrolled in this study.According to the clinical symptoms,basic status and related examination before and after admission,ECG,myocardial enzymes,electrocardiogram after admission,the characteristic changes of myocardial enzymes,coronary angiography diagnosed as coronary heart disease patients.All subjects were diagnosed with coronary heart disease,received PCI,double antiplatelet therapy and discharged smoothly.The diagnosis was based on the use of double antiplatelet drugs by distinguishing patients from the use of double antiplatelet medication in 157 cases(aspirin 100 mg Qd + ticagrelor 90 mg bid)and clopidogrel group 220(aspirin 100 mg Qd + clopidogrel 90mg bid).Clinical end point:composite end point for all-cause death,non-fatal recurrent myocardial infarction,stent thrombosis,new stroke,severe bleeding events,no plans to revascularization again,due to heart failure re-admission,stent thrombosis And other clinical events.The main safety end points were:bleeding and bleeding.Among them,the major bleeding event defined as the American Society for Hemorrhage(BARC)to develop bleeding classification criteria in type 3 and 5 bleeding,small bleeding time defined as BARC1 and type 2 bleeding.Laboratory end point:The PL-12 instrument monitors the ADP values for different drugs.Result1,1-1 patients admitted to the basic situation:the study selected 370 patients with PCI.clopidogrel group of 217 patients,30 patients with ticagrelor group.There were 104 patients(35%vs 47.3%,P<0.05)in 55 patients with myocardial infarction in the ticagrelor group.There were 36 cases(36.5%vs 7.4%,P<0.05)in 36 cases of PCI.Such as age,BMI and previous history such as history of heart failure,history of myocardial infarction,history of hypertension,history of stroke,history of smoking,family history of coronary heart disease and CABG history were not statistically significant(P>0.05);(6.5%vs8.9%,P<0.05).The length of implanted stent group was higher than that of clopidogrel group(P<0.05)(P<0.05).The number of multi-vessel lesions in the ticagrelor group was higher than that in the clopidogrel group(P<0.05),and the difference was statistically significant(P<0.05)(54.9%vs 41%,P<0.05).There was no significant difference between the two groups(P>0.05).There was no significant difference between the two groups(P>0.05).The levels of PTT(prothrombin time),fib(fibrinogen),INR(international normalized ratio),D-dimer,Blood glucose,liver and kidney function,blood lipid,glycosylated hemoglobin,myocardial markers and other two groups between the two groups were no significant difference(P>0.05).2,in the hospital:the two groups of patients selected non-medication part of the patients measured clopidogrel group and ticagrelor group based AA were67.7(60.20-71.15)%and 66.4(60.1-78.95)%(P>0.05)ADP were 66.1(60.45-69.2)%and 66.1(55.6-73.3)%,preoperative AA,preoperative ADP,postoperative AA,postoperative ADP(P>0.05).3,3-1 1 month:clopidogrel group AA was higher than ticagrelor group(30.4(25.45-39.9)vs 28.1(22.15-34.2),P<0.05).The ADP value of clopidogrel group was higher than that of ticagrelor group(37.3(23.4-43.7)Vs 34.2(28.1-42.1),P<0.05).3-2 3 months:AA value of clopidogrel group was higher than that of ticagrelor group(30.1(23.1-36.6)%vs 27.6(22.65-33.2)%,P<0.05).The ADP value of clopidogrel group was higher than that of ticagrelor group(40.6(26.85-44.7)%vs 34(24.4-42.8)%,P<0.05).4,a.l months:217 people in the clopidogrel group,29 with BARC type 1,153 for the genitals Bleeding type of 66 people.The level of BARC1 hemorrhage in the clopidogrel group was less than that in the ticagrelor group(13.4%and 43.1%,P<0.05)b.3 months:249 people in the clopidogrel group,33 had a type 1 hemorrhage,121 were in the genitals46 people.BARC1 type bleeding was less than that of ticagrelor group(13.4%and 43.I%,P<0.05).5,dressing group:in 1 month when the replacement of gemcitabine clopidogrel group can be seen:before and after dressing AA value on both sides was no significant difference(30.8(23.05-42.73)vs(33.28-44.2),P<0.05),BARC1(40%vs 20%,P<0.05).6,6-1(1)>65 years old patients in a.Preoperative AA,ADP and 1 month AA group was not statistically poor(P>0.05).Monthly follow-up of clopidogrel ADP was higher than that of ticagrelor group(38(23.4-43.95)vs 30.1(22.83-42.2)%,P<0.05).Clopidogrel group b BARC type 1 hemorrhage was significantly more than clopidogrel(9.5%vs 31.7%P<0.05).(2)? 65 years of age in patients with preoperative AA,ADP and 1 month follow-up between the two groups were no significant difference(P>0.05).At the 1-month follow-up,AA was higher in the clopidogrel group than in the ticagrelor group(30.4(26-40.2)vs 27.8(22.2-34.2)%,P<0.05).B.Clopidogrel group 1 was less bleeding than the ticagrelor group(17%vs 50.5%,P<0.05).6-2(1)normal renal function group:a.Preoperative ADP,preoperative AA,1 month ADP no significant difference(P>0.05);The AA value of the month was lower than that of the clopidogrel group(27.8(22.2-34.2)vs 30.4(26-40.2),P<0.05)b.The type of BARC 1 hemorrhage in the ticagrelor group was lower in the clopidogrel group than in the group(13.4%vs 43.1%,P<0.05)(2)There was no significant difference between the two groups(P>0.05)in the a.AA and ADP groups of renal insufficiency group.At 1 month,AA and ADP(P>0.05);b.In the two groups in the small bleeding,clopidogrel group was 1(4.5%)people,There was no significant difference between the two groups(P>0.05).6-3(1)male:a.Preoperative AA,preoperative ADP,1 month AA no significant difference(P>0.05).1 month The level of ADP in clopidogrel was higher than that in ticagrelor group(37.3(23.4-43.7)vs 32.2(22.95-42.7,P = 0.07)There was no statistically significant difference.B.In the case of BARC1 hemorrhage,the clopidogrel group was less than ticagrelor(13%Vs 22.2%,P<0.05=.(2)There was no significant difference between the two groups(P>0.05).There was no significant difference between AA and ADP(P>0.05);b.In the two groups in the small bleeding,clopidogrel group was 7(13%),Group was 8(22.2%),the two groups no significant statistical difference(P>0.05).In conclusion1,Ticagrelor was significantly more effective than clopidogrel.and safety was defined by BARC-defined type 1 bleeding significantly more than clopidogrel.2,Ticagrelor affect the arachidonic acid pathway metabolic pathway,in the inhibition of platelet aggregation in the superposition of the role.3,There was no significant difference in the inhibitory rate of ticagrelor and clopidogrel in the group of<65 years old,renal insufficiency group,female group and male group.4,BRCR 1 in renal insufficiency group and female group have no difference.