Application of thrombelastogram in reviewing curative effect of ticagrelor in elderly patients with coronary heart disease and clopidogrel resistance

XIA Chang-quan; ZHANG Wei; WU Yun-tao; LIU Hui; TIAN Guo-xiang; WANG Xio-bing; LI Juan; YAO Lu

doi:10.3969/j.1674-4055.2015.04.17

Abstract：Objective To observe the curative effect of ticagrelor in elderly patients with coronary heart disease (CHD) and clopidogrel resistance through monitoring ADP-induced platelet inhibition rate by using thrombelastogram (TEG). Methods The elderly patient with acute coronary syndrome (ACS) and clopidogrel resistance after percutaneous coronary intervention (PCI, n=31, including 10 with ACS and 21 with PCI, male 27, female 4 and aged over 75) were chosen from Oct. 2012 to Dec. 2014, and divided into clopidogrel group (n=15) and ticagrelor group (n=16). The clopidogrel group was keeply given clopidogrel (75 mg/d) and ticagrelor group was given ticagrelor (90 mg) twice a day for 8 w. The changes of platelet inhibition rate were observed at different time points including before, 1 w, 4 w, and 8 w after drug taking. The incidence of major adverse cardiovascular events (MACE) was compared between 2 groups. Results Compared with clopidogrel group, ADP-induced platelet inhibition rate increased in ticagrelor group after 1 w [(22.6±4.5)%vs. (35.8±5.7)%], 4 w [(21.9±4.6)%vs. (36.9 ±5.5)%] and 8 w [(22.8±4.6)%vs. (37.1±5.2)%, all P<0.05]. There was 1 case with myocardial infarction, 5 with relapsed angina pectoris (totally 6, 40%) in clopidogrel group, and 1 with mild dyspnea (relieved after 3 d without any special treatment) and 1 with relapsed angina pectoris (totally 1, 6.3%) in ticagrelor group. The incidence of MACE was higher in clopidogrel group than that in ticagrelor group (40% vs. 6.3%, P<0.05). Conclusion Clopidogrel is replaced with ticagrelor can significantly increase ADP-induced platelet inhibition rate and decrease incidence of MACE with higher safety and tolerability in elderly patients with CHD and clopidogrel resistance.