Study Of Individual Antiplatelet Agents After Pci For CYP2C19*2 Patients With Acute Coronary Syndrome

Objective:To investigate the ticagrelor and double dose clopidogrel for carrying CYP2C19*2 gene mutation of ACS after PCI in patients with clinical efficacy and the risk of bleeding and provide evidence-based reference for clinical individualized antiplatelet therapy.Methods: Select 192 patients with genotype CYP2C19*2 from January 2014 to January2016 with ACS.All patients were successfully treated with PCI.Randomly divided into 2groups.(ticagrelor,n=91)group were treated with ticagrelor + aspirin(ticagrelor 90 mg,bid,aspirin 100 mg,qn),Double dose clopidogrel group(n=91)received a double dose of clopidogrel plus aspirin(clopidogrel 150 mg,qd,aspirin 100 mg,qn).Use TEG to detect the platelet inhibition rate changes.And follow-up and compare the occurrence of adverse cardiovascular events and bleeding events of two groups.Results: The clinical data of the two groups were compared: gender,age,risk factors have no difference.There was no difference between conventional drugs(including beta blockers,ACEI or ARB,statins,).There was no difference in the number of blood vessel and stent implantation(P>0.05).Two groups of patients with platelet function contrast:the use of different antiplatelet regimens in the treatment of the two groups of PCI platelet inhibition rate was no significant difference.(P > 0.05).At 6 months and 12 months,the platelet inhibition rate of the two groups was higher than that before the operation.(P <0.05),the comparison between the two groups: the platelet inhibition rate was higher in the treatment group than in the double dose clopidogrel group.There was no significant difference between the two groups in the clinical curative effect and the incidence of bleeding events between the two groups.(P > 0.05).Other adverse reactions Use of ticagrelor in patients with dyspnea occurred in 4 cases,including 3 cases of mild and tolerable,taking Aminophylline Sustained-release Tablets can reduce symptoms,not stopping.There are 1 cases of patients with severe respiratory difficulties after taking drugs,oral theophylline drugs can not be alleviated,so stop using.Conclusion : For patients with CYP2C19*2 gene mutations,the use of ticagrelor or double dose clopidogrel can achieve higher platelet inhibition rate.Using ticagrelor,platelet inhibition rate is stronger,but there is no difference between the two groups of MACE events.The results showed that the platelet inhibition rate reached a certain degree,and then increased platelet inhibition rate,and can not get higher efficacy.Ticagrelor and double dose clopidogrel used in CYP2C19*2 gene mutation have the same efficacy and safety.