Efficacy and safety of ticagrelor versus clopidogrel with different dosage in high-risk patients with acute coronary syndrome

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• 作者：Yan-guo Xin^a ; ^c ; Hai-shan Zhang^b ; Yu-ze Li^b ; Qi-gang Guan^b ; Liang Guo^b ; Yuan Gao^b ; Hai-jie Yu^b ; Xin-gang Zhang^b ; Feng Xu^b ; Yue-lan Zhang^b ; Da-lin Jia^b ; Ying-xian Sun^b ; Guo-xian Qi^a ; Wen Tian^a ; ^{dr_wentian@163.com}
• 关键词：Acute coronary syndrome ; Antiplatelet therapy ; Ticagrelor ; Clopidogrel ; In-stent thrombosis ; Target vessel revascularization
• 刊名：International Journal of Cardiology
• 出版年：2017
• 出版时间：1 February 2017
• 年：2017
• 卷：228
• 期：Complete
• 页码：275-279
• 全文大小：392 K
• 卷排序：228

文摘

Dual antiplatelet therapy is recommended as a standard antiplatelet strategy in acute coronary syndrome. For those with reduced pharmacologic response to clopidogrel, strengthening antiplatelet therapy (clopidogrel 150 mg daily) may reduce adverse clinical events. Ticagrelor is a direct-acting inhibitor of the adenosine diphosphate receptor P2Y12 that has a more rapid onset and offset than clopidogrel.MethodsIn this retrospective study, we compared ticagrelor (180 mg loading dose 90 mg twice daily thereafter), clopidogrel (300 mg loading dose, 75 mg or 150 mg daily thereafter) for the prevention of cardiovascular events in 273 high-risk patients admitted to coronary care unit with acute coronary syndrome.ResultsThe rate of IST in hospital was significantly reduced in patients of ticagrelor group comparing with those receiving clopidogrel 75 mg (0.69% vs 8.2%, p = 0.009). Moreover, the TVR rate was less in the ticagrelor group than clopidogrel 75 mg group (2.7% vs 13.1%, p = 0.007) 6 months follow-up. The incidence of MACCE has no difference between the two clopidogrel groups. Kaplan–Meier analysis of MACCE-free indicated that there was no difference between the three groups. Ticagrelor significantly increased the rate of minor bleeding compared with clopidogrel 75 mg daily during hospital (45.5% vs 26.2%,p = 0.012) and 6-month follow-up (66.9% vs 45.9%,p = 0.004).Bleeding-free prognosis was significantly better in the clopidogrel 75 mg daily group.ConclusionsIn patients with acute coronary syndrome undergoing PCI, the rate of in-stent thrombosis and TVR were significantly reduced treated with ticagrelor compared with clopidogrel 75 mg daily, without an increase of overall major bleeding, but with an increase of minor bleeding.