Thromboelastography To Evaluate The Antiplatelet Effect Of Ticagrelor And Clopidogrel On Patients With Different Genotypes

Objective: Comparison of antiplatelet effects of ticagrelor and clopidogrel in patients with acute coronary syndrome using thrombelastograms;evaluation of ticagrelor and clopidogrel in patients with different genotypes by different indicators of thrombelastogram The antiplatelet effect;Comparing major adverse cardiac events and bleeding episodes with ticagrelor and clopidogrel after 6 months of follow-up.Methods: A total of 189 patients undergoing percutaneous coronary intervention for the diagnosis of acute coronary syndrome at the Department of Cardiology,First Affiliated Hospital of China Medical University from April 1,2015 to April 1,2017 were selected.Cases,all taking aspirin as the basic antiplatelet drug,divided into two groups according to the combination of drugs,a group of ticagrelor combined with aspirin in 42 cases,another group of 147 cases of clopidogrel combined with aspirin,using the principle of chip reagents Cytochrome P450 enzyme system(CYP2C19)genotyping,divided into three types,type I fast metabolizing type(CYP2C19*1/1),type II intermediate metabolizing type(CYP2C19*1/2,CYP2C19*1/3),Type III is a slow metabolizer(CYP2C19*2/2,CYP2C19*2/3,CYP2C19*3/3)and analyses the gender,age,smoking history,low-density lipoprotein cholesterol,total cholesterol,triglycerides in both treatment groups.Blood creatinine,glycated hemoglobin,hypertension,diabetes,and medications such as angiotensin-converting enzyme inhibitors/angiotensin II receptor inhibitors,statins,proton pump inhibitors,and beta blockers Does the comparison have statistics? Differences in learning;comparison of statistical differences between thrombo-elastograms in the two treatment groups;statistical differences between three different genotypes in the clopidogrel and ticagrelor groups;and comparison of three different genotypes;Statistical differences in thrombo-elastograms between the two treatment groups were statistically significant;the occurrence of major adverse cardiac events and bleeding events was compared between the two treatment groups at the telephone follow-up of 6 months.Results:1.Comparison of basic clinical data between the two treatment groups: There was no statistical difference between the clopidogrel group and the ticagrelor group(P>0.05).2.Comparison of two sets of thromboelastograms: The inhibition rate of adenosine diphosphate(ADP)in the clopidogrel group was 56.96±26.56%,which was lower than that of the tigrizol group(67.88 ± 28.19%,P=0.022,the difference was statistically significant).P<0.05);The maximum clot intensity(MAADP)induced by adenosine diphosphate in the clopidogrel group was 35.20 ± 16.52 mm higher than that of the tigralil group by 25.82 ± 15.35 mm,P=0.001,and the difference was statistically significant(P< 0.05);clopidogrel group maximum clot strength(MA)66.02 ± 5.38 mm higher than the ticagrelor group 59.55 ± 6.07 mm,P=0.000,the difference was statistically significant(P <0.05).3.The inhibition rates of three different genotypes of ADP in clopidogrel group were:fast metabolic type 55.62 ± 29.14% a,intermediate metabolic type 56.26 ± 27.87%a greater than slow metabolic type 35.60 ± 12.19%,P=0.017,the difference was statistically significant Significance(P<0.05);There was no statistical difference between MAADP and MA(P>0.05).4.There was no significant difference in ADP inhibition rate,MAADP,MA between three different genotypes in the ticagrelor group(P>0.05).5.Comparison of thromboelastograms between fast-metabolized,intermediate-metabolized,and slow-metabolized groups in the two treatment groups:ADP inhibition rate in clopidogrel group was lower than that in ticagrelor group,and MA value was higher than that in ticagrelor group.Statistically significant(P<0.05).6.The incidence of minor bleeding episodes in the two treatment groups was 23.8% in the ticagrelor group and 9.5% in the clopidogrel group(P=0.024).The difference was statistically significant(P<0.05).The major adverse cardiac events were There was no statistical difference(P>0.05).Conclusion: 1.The ticagrelor group had stronger inhibition of platelets than the clopidogrel group.2.The variation of genotype affects the antiplatelet effect of clopidogrel,in which the fast metabolizing type and the intermediate metabolizing type are superior to the slow metabolizing type,but ticagrelor is not affected by the genetic variation.3.Small bleeding events in the ticagrelor group were higher than those in the clopidogrel group.There were no differences in major adverse cardiac events.