Follow-up Study Of Antiplatelet Drugs In Patients With Acute Coronary Syndrome

Objective:To explore the incidence,causes and related factors of premature ticagrelor discontinuation in patients with acute coronary syndrome?ACS?,and to analyze the selection of clinical antiplatelet drugs compared with clopidogrel in retrospective and prospective follow-up study.Methods:1.Retrospective analysis of premature ticagrelor discontinuation in patients with ACS during follow-upFrom January 2018 to October 2018,400 hospitalized patients with ACS who were treated with aspirin and ticagrelor in the Department of Cardiology,Changhai Hospital,Naval Military Medical University were recruited.Baseline data were collected and patients were followed up to analyze the incidence,causes and related factors of premature ticagrelor discontinuation in ACS patients.2.Prospective study of antiplatelet drug use in patients with ACS616 hospitalized patients with ACS who were treated with dual antiplatelet therapy?DAPT?in the Department of Cardiology,Changhai Hospital,Naval Military Medical University from January 2019 to June 2019 were included and divided into two groups according to clinical drug selection:ticagrelor group?423 cases?and clopidogrel group?193 cases?.The baseline data of two groups were collected respectively,and all the patients in the two groups were followed up.The incidence and reasons of drug discontinuation were compared,and the related factors of P2Y₁₂ receptor antagonist selection and factors related to premature discontinuation of P2Y₁₂ receptor antagonist were analyzed.Results:1.Retrospective analysis of premature ticagrelor discontinuation in patients with ACS during follow-up?1?The incidence of premature ticagrelor discontinuation in ACS patients was12.3%,lower than that in current reports.?2?The three main causes of premature ticagrelor discontinuation were dyspnea,drug inaccessibility and bleeding.Premature ticagrelor discontinuation due to dyspnea occurred in all the patients whose m MRC was Grade 2 or higher than Grade 2.The proportion of patients with premature ticagrelor discontinuation due to bleeding was lower than that in current reports,and some patients stopped aspirin and used ticagrelor alone.?3?Most of premature ticagrelor discontinuation occurred within three months after discharge,especially within one month after discharge.?4?Age>75 years old?OR:2.58,95%CI:1.26-5.26,P=0.009?and urea rise?OR:1.17,95%CI:1.04-1.30,P=0.007?were independent predictors of premature ticagrelor discontinuation,while the degree of vascular stenosis?OR:0.95,95%CI:0.92-0.98,P=0.001?was the related factor of adherence to ticagrelor.2.Prospective study of antiplatelet drug use in patients with ACS?1?The number of patients in our hospital who chose ticagrelor for DAPT was more than twice that of clopidogrel.The utilization rate of ticagrelor in emergency operation was significantly higher than that of clopidogrel.The related factors of choosing ticagrelor were ST-elevation myocardial infarction?STEMI?,smoking history and hypertension,and the related factor of choosing clopidogrel was Non-ST segment elevation acute coronary syndrome?NSTE-ACS?.?2?The incidence of premature discontinuation in ticagrelor group was significantly higher than that in clopidogrel group?9.7%vs 4.1%,P=0.018?,and the risk of premature discontinuation in ticagrelor group was three times higher than that in clopidogrel group?HR:3.09,95%CI:1.21-7.89,P=0.018?.The number of patients with premature ticagrelor discontinuation due to dyspnea was significantly higher in ticagrelor group than in clopidogrel group?3.3%vs 0.5%,P=0.046?.?3?The incidence of bleeding events in ticagrelor group was significantly higher than that in clopidogrel group?6.1%vs 2.1%,P=0.029?,and the incidence of dyspnea in ticagrelor group was significantly higher than that in clopidogrel group?5.9%vs 0.5%,P=0.002?.?4?The median time of discontinuation was 70 days after discharge in ticagrelor group and 39 days after discharge in clopidogrel group.The time of clopidogrel discontinuation was significantly earlier than the time of ticagrelor discontinuation?Log-Rank P=0.032?.Conclusions:1.For the selection of P2Y₁₂ receptor antagonist in ACS patients,the main choice is ticagrelor in clinical,especially for patients with STEMI or emergency surgery.The utilization rate of ticagrelor is 80.8%and 85.7%respectively because of the strong and quick antiplatelet effect of ticagrelor.Therefore,it is more advantageous to use ticagrelor as first choice for DAPT in ACS patients with STEMI or emergency surgery.2.The incidence of premature ticagrelor discontinuation was 9.7%?12.3%.The incidence of premature discontinuation was significantly higher in patients with ticagrelor than in patients with clopidogrel,and the risk of premature ticagrelor discontinuation was approximately three times that of clopidogrel.Most of premature ticagrelor discontinuation occurred within three months after discharge.Therefore,strengthening education and follow-up are important approaches to prevent cardiovascular events caused by premature discontinuation and improve prognosis.3.The main causes of premature ticagrelor discontinuation were dyspnea,drug inaccessibility and bleeding.Dyspnea is the most common cause.If the m MRC score is Grade 2 or above,P2Y₁₂ receptor antagonist should be replaced in time to reduce the incidence of thrombotic events caused by self discontinuation.We should pay more attention to the elderly patients?age>75 years old?and those with related factors of dyspnea?heart failure,COPD,?-blocker?.When choosing P2Y₁₂ receptor antagonist,we should consider comprehensively to avoid unnecessary premature discontinuation,which may lead to the increase of cardiovascular events.4.For premature ticagrelor discontinuation due to adverse drug reactions,the replacement of ticagrelor with clopidogrel is currently adopted.Reducing the dosage of ticagrelor may also be an important method to reduce the incidence of adverse reactions and premature discontinuation,which needs to be further confirmed in clinical practice.