Comparing The Safety And Effectiveness Between Appropriate P2Y12 Inhibition By Clopidogrel And Ticagrelor In ACS Patients

Objective To explore the differences between oral aspirin and clopidogrel with aspirin and ticagrelor after coronary artery stenting.Methods The 150 Patients who had undergone percutaneous coronary intervention(PCI)were selected from August,2016 to February,2017.1.According to the different oral medication of clopidogrel or ticagrelor,this study split 150 patients into two groups,such as group of aspirin with clopidogrel(group 1: 88 cases)and group of aspirin with ticagrelor(group 2: 62 cases);2.Both of the two group patients were given conventional oral aspirin loading of 300 mg with 100 mg daily maintenance dose.While the first group was given by clopidogrel(Bo Livisanofi(Hangzhou)Pharmaceutical Co.Ltd)300mg load with clopidogrel(Bo Livisanofi(Hangzhou)Pharmaceutical Co.Ltd.)75mg daily maintenance dose as an extra medicine;the second group was given by ticagrelor(Astra Zeneca)180mg loading dose with 90 mg twice daily as a maintenance dose at the same time;3.According to the indications and the principle of individualization,each patient of the two groups patients can be combined with statins,the corresponding doses of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers,beta blockers,calcium antagonists,nitrates drugs treatment;4.The patients in the first group should be extracted 2ml venous blood after the dual antiplatelet therapy drugs were taken orally after 24 hours,which will be used to dectct the Platelet reaction index(PRI)and the phosphorylation degree of vasodilator-stimulated phosphoprotein.The patient will be excluded if his or her PRI not lower than 61%;5.The average follow-up time of the study is 6 months.And the study was aim at exploring the differences between clopidogrel and ticagrelor,by recording and analyzing the clinical situation between the two groups of patients with major adverse cardiovascular events(thrombosis,cardiac death,nonfatal myocardial infarction,stroke,target vessel revascularization,overall mortality,recurrent angina and stent);6.The primary endpoint was the major adverse cardiac and cerebral vascular events,the secondary end point was the major hemorrhagic event.Results The study takes 180 days to fellow-up all these patients.In the end,patients who oral oclopidogrel combined with aspirin were older and more likely to present non-ST segment elevation myocardial infarction,cardiovascular risk factors,atrial fibrillation,or prior vascular disease.After propensity score matching,the primary endpoint was met in 8.6% of the clopidogrel group and 4.9% of the ticagrelor combined with aspirin group(p=0.42>0.5).Minor bleedingevents were significantly reduced in the clopidogrel combined with aspirin group(1.7% vs 11.5%;p=0.034<0.05).In PCI-treated ACS patients,the patients who's PRI<61% after clopidogrel combined with aspirin therapy were not associated with increased risks of thrombotic events compared to ticagrelor combined with aspirin therapy.Conclusion In PCI-treated ACS patients,the patients who's PRI<61% after clopidogrel combined with aspirin therapy were not associated with increased risks of thrombotic events compared to ticagrelor combined with aspirin therapy.There was no obvious difference between the two groups in major bleeding events with a lower minor bleeding risk in group clopidogrel.The dysapnea risk also founed higher in ticagrelor.