Relieve effect of ticagrelor on clopidogrel resistance in patients with non-ST elevation-acute coronary syndrome

HE Xue-kui; ZHAO Ying-juan

doi:10.3969/j.issn.1674-4055.2017.02.25

Abstract：Objective To review the curative effect and safety of ticagrelor through thrombelastogram (TEG) in treatment clopidogrel resistance in patients with non-ST elevation-acute coronary syndrome (NSTE-ACS) after percutaneous coronary intervention (PCI).Methods NSTE-ACS patients with clopidogrel resistance affirmed by TEG (n=120, platelet inhibition ratio<30% induced by ADP detected with TEG during regular taking clopidogrel) were chosen from the Department of Cardiovasology of the Second Affiliated Hospital of Shaanxi University of Chinese Medicine. All patients were randomly divided into clopidogrel group (150 mg once a day) and ticagrelor group (90 mg twice a day, eachn=60), and then were given re-examination of TEG after treatment for 5 d and 1 m. The changes of platelet inhibition ratio induced by ADP were compared between 2 groups. The patients were followed up for 3 m, and the incidence of adverse reactions and major adverse cardiovascular events (MACE) were compared between 2 groups.Results The difference in age, sex and complications had no statistical significance between 2 groups (P>0.05). The platelet inhibition ratio induced by ADP increased after treatment for 5 d and 1 m in 2 groups (P<0.05), which was more significant in ticagrelor group compared with clopidogrel group (P<0.05). After treatment for 3 m, there were no severe bleeding events observed in 2 groups. There were 4 cases of mild bleeding in clopidogrel group, and 7 of mild bleeding and 4 of mild dyspnea in ticagrelor group (P>0.05). There were 5 cases of MACE in clopidogrel group and 2 in ticagrelor group, and ticagrelor had a trend of reducing MACE incidence, but the difference had no statistical significance (P>0.05).Conclusion Clopidogrel in higher dose and ticagrelor in routine dose all can reduce platelet reactivity, while ticagrelor's effect is more significant and it has a trend of reducing MACE incidence.