The Influence Of Statins With Different Metabolic Pathways On Platelet Inhibition Of Ticagrelor In Patients With Acute Coronary Syndromes

Objective:Now antiplatelet treatment is frequently used in high-risk patients with acute coronary syndromes(ACS)who are also often treated with stains.Ticagrelor is a new P2Y12 receptor inhibitor and metabolized through cytochrome CYP3A4 in liver.Some scholars indicated that,ticagrelor antiplatelet activity may be reduced due to the competitive inhibition with other CYP3A4 substrates.Aatorvastatin is metabolized through cytochrome CYP3A4 and rosuvastatin is not metabolized through cytochrome CYP3A4.They are often used in combination with ticagrelor in the clinic.The AA induced platelet inhibition rate and the ADP induced platelet inhibition rate were measured by TEG 7 days after patients taking the drug,and compared the difference of the data.Comparison of the influence on the platelet aggregation of ticagrelor combined with different metabolic pathways statins and the incidence of long-term adverse cardiovascular events.Methods:A total of 80 patients who were diagnosed as acute coronary syndromes(ACS)in the fist affiliated hospital of Xiamen University were enrolled between June 2016 and June 2017.All the patients received standard antiplatelet treatment including aspirin 100 mg/qd.,ticagrelor 90 mg/bid.and low molecular heparin 5000U/12h by hypodermic injection for seven days.The patients were randomly divided into groups of A and B.The group A patients(n=40)were taking atorvastatin 20mg/d for half an hour before bedtime and the group B patients(n=40)taking rosuvastatin 10mg/d for half an hour before bedtime.The changes of platelet inhibition rate were observed at different time points including before and 7days after drug taking by TEG.Observating the influence of statins with different metabolic pathways on platelet inhibition of ticagrelor in patients with acute coronary syndromes.Results:1.The inhibition rate of platelets in AA pathway and ADP pathway,the response time(R)and blood clot formation time(K)were significantly higher in group A and B than those before treatment.The MA-ADP value and alpha angle were decreased obviously,the difference was statistically significant(P<0.05).2.There was no significant difference between the parameters of the TEG between the two groups of patients with A and B after threatment(P>0.05).3.Follow-up half a year the incidence of major adverse cardiovascular and cerebrovascular events were assessed,including stroke,cardiovascular death,myocardial infarction,and relapsed angina pectoris.The difference had no significance(P>0.05).Conclusion:1.Compared with the patients before and after taking drugs,the platelet inhibition rate in group A and B increased significantly.However,atorvastatin,which is metabolized through cytochrome CYP3A4 or rosuvastatin,which is not metabolized through cytochrome CYP3A4,has no significant difference in platelet inhibition effect in the short term.2.There was no significant difference in the incidence of adverse cardiovascular events in the two groups of A and B patients during hospitalization and later follow-up.