A Study About Efficiency And Security Of Ticagrelor In Elderly Patients With Unstable Angina

Objective:By following-up the incidence of the major adverse cardiac events,hemorrhage,general adverse reactions and the change of liver function,kidney function,uric acid,the brain natriuretic peptide(BNP)and high sensitive C-reactive protein(hs-CRP)between ticagrelor and clopidogrel in elderly patients with unstable angina.To assess the efficiency and security of ticagrelor in the elderly patients.Methods:A total of 88 patients with unstable angina were admitted to tianjin first central hospital,international medical center in February 2015 to October 2016 and older than 60.According to the random number table method,they were randomly divided into ticagrelor group and clopidogrel group.There are 44 patients in each group.The ticagrelor group received ticagrelor(180 mg loading dose,90 mg maintenance dose,twice daily)and aspirin(100 mg maintenance dose,once daily),the clopidogrel group received clopidogrel(300 mg loading dose,75 mg maintenance dose,once daily)and aspirin(100 mg maintenance dose,once daily).Two groups both apply the regular drugs of guidelines recommend in secondary prevention of coronary heart disease,such as beta-blockers,statins,angiotensin converting enzyme inhibitors(ACEI),angiotensin ? receptor antagonist(ARB),nitrate medications and other drugs.Record the basic clinical information of the two group patients.Detect the concentration of serum creatinine,uric acid,propylene valley transaminase,BNP and hs-CRP in the two groups respectively before medicine and after 1 month.Observe and compare the incidence of major adverse cardiovascular events(cardiac death,myocardial infarction,and recurrent angina pectoris,heart failure,cerebral thrombosis),hemorrhage and general adverse drug reactions(dyspnea,bradycardia)between the two groups.In order to observe the efficiency and security of ticagrelor in elderly patients with unstable angina pectoris.Results:1.General basic baseline data There was no significant statistical difference between the two groups in generalbasic information(age,gender,smoking history,drinking history,body mass index,platele,total cholesterol,triglyceride,LDL cholesterol,HDL cholesterol)and related cardiovascular risk factors(hypertension,cerebral infarction and diabetes)(P>0.05).2.The comparison of efficiency2.1The comparison of serum levels of BNP and hs-CRP Before treatment,There was no significant difference in serum levels of BNP between ticagrelor group and clopidogrel group(P>0.05).After one month of oral dual antiplatelet therapy,the level of BNP decreased in both groups,and the ticagrelor group is lower,the difference was statistically significant(P<0.05).Before treatment,There was no significant difference in serum levels of hs-CRP between ticagrelor group and clopidogrel group(P>0.05).After one month of oral dual antiplatelet therapy,the level of hs-CRP decreased in both groups,and the ticagrelor group is lower,the difference was statistically significant(P<0.05).2.2The observation of major adverse cardiac events Following-up and observing the two groups,there were no significant cardiovascular events such as cardiac death,acute myocardial infarction,heart failure and cerebral thrombosis in both groups.There were 4 cases of recurrent angina in the ticagrelor group and 8 cases of recurrent angina in the clopidogrel group,but there was no significant difference between the two groups(P = 0.352).3.The comparison of security3.1The comparison of serum levels of liver and kidney function,blood uric acid In ticagrelor group,there was no significant difference in propylene valley transaminase and creatinine between before and after medication(P>0.05);Compared with before treatment,The serum level of uric acid increased after treatment,the difference was statistically significant(P=0.004).In clopidogrel group,there was no significant difference in propylene valley transaminase,creatinine and uric acid between before and after treatment(P>0.05).After one month of oral dual antiplatelet therapy,compared with clopidogrel group,no significant difference was found in propylene valley transaminase andcreatinine between the two groups(P>0.05).The level of uric acid for ticagrelor group was higher than clopidogrel group,the difference was statistically significant(P=0.001).3.2The observation of adverse reactions The two groups both did not appear the main fatal/life-threatening bleeding,major bleeding and seccondary bleeding.The incidence of milld bleeding of ticagrelor group was higher than clopidogrel group(13.64% vs.4.55%),but there was no significant difference between the two groups(P = 0.266).In ticagrelor group there were 6 cases of minor hemorrhage,including 4 cases of subcutaneous hemorrhage,2cases of gingival bleeding;In clopidogrel group,1 case of subcutaneous hemorrhage and gingival bleeding occurred,alleviate by oneself.In ticagrelor group appeared 2cases mild dyspnea,alleviate by oneself without drug withdrawal,untreated;clopidogrel group did not appear dyspnea.There was no slow arrhythmia during the follow-up period.Conclusion:Compared with clopidogrel,ticagrelor decreased the serum levels of BNP and hs-CRP,did not increase the main adverse cardiac events and major bleeding events,the incidence of serious bleeding events and the liver and kidney function was no significant change in elderly patients with unstable angina,it is effective and safe in the elderly population.