Bleeding risk of ticagrelor treating acute coronary syndrome patients after percutaneous coronary intervention

Liu Dongting; Zhou Yujie; Wang Zhijian; Wu Sijing

doi:10.3760/cma.j.issn.1673-4777.2018.03.002

Abstract：Objective To observe the bleeding risk of ticagrelor in treatment of acute coronary syndrome (ACS) patients after percutaneous coronary intervention (PCI).Methods ACS patients who had PCI from January 2013 to June 2015 in Beijing Anzhen Hospital,Capital Medical University were enrolled;patients who accepted dual antiplatelet therapy(DAPT) with ticagrelor were as ticagrelor group;patients who accepted DAPT with clopidogrel were matched(1:1) by sex and age as clopidogrel group.All patients took enteric-coated aspirin and ticagrelor or clopidogrel for DAPT.Bleeding events that were not related to coronary artery bypass graft (CABG) were defined as the primary endpoint according to the PLATO standard.Risk factors of bleeding in 12 months were analyzed by univariate and logistic regression analysis.Results Totally 936 cases were enrolled,with 468 cases (358 males) in each group.The 1 year non-CABG-related bleeding rate in ticagrelor group was significantly higher than that in clopidogrel group [19.2％ (90/468) vs 4.9％ (23/468)];oral gingival bleeding,gastrointestinal bleeding and nasal bleeding rates in ticagrelor group were significandy higher than those in clopidogrel group[7.1％ (33/468) vs 0.6％ (3/468),2.6％ (12/468) vs 0.4％ (2/468),3.8％ (18/468) vs 0.9％ (4/468)];dyspnea rate and drug withdrawal rate in ticagrelor group were significantly higher than those in clopidogrel group[11.8％ (55/468) vs 0.2％ (1/468),22.6％ (106/468) vs 1.3％ (6/468)] (all P ＜ 0.05).Logistic regression analysis showed that female (odds ratio =2.01,95％ confidence interval:1.16-5.28,P =0.007) and low body mass(odds ratio =1.02,95％ confidence interval:1.00-1.03,P =0.033) were independent risk factors of bleeding in patients with DAPT;the bleeding risk of ticagrelor was significantly higher than that of clopidogrel(odds ratio =5.18,95％ confidence interval:3.09-8.67,P ＜ 0.001).Conclusion Ticagrelor has a higher bleeding risk than clopidogrel in treating ACS patients with DAPT after PCI.