Comparison of Ticagrelor and Clopidogrel for Patients Undergoing Emergency Percutaneous Coronary Intervention
Abstract
Background: We compared treatments with the antiplatelets ticagrelor and clopidogrel used in patients with acute myocardial infarction (AMI) during the perioperative period for emergency percutaneous coronary intervention (PCI).
Methods: A total of 120 patients were selected and randomly divided into control and observation groups (60 patients in each) from 2014- 2016 at The Affiliated Hospital of Qingdao University. The patients in the control group received 300 mg clopidogrel and 300 mg aspirin for oral administration, while those in the observation group were given 180 mg ticagrelor and 300 mg aspirin orally prior to the PCI. During the operation, heparinization and a tirofiban micro-pump were used continuously.
Results: Coronary artery and peripheral venous blood were extracted from each patient to obtain various parameters of thrombelastogram (TEG), and the maximum platelet aggregation rates in order to compare antiplatelet effects. Major adverse cardiac events (MACE) were recorded during the following 6-month follow-up. Analysis of the data showed no differences in terms of the time span between medication intake and stent implantation, or the dosage of heparin and tirofiban used between the two groups. Before stent implantation, and 24 and 48 h after the procedure the average R and K values of TEG in coronary artery blood and peripheral venous blood samples in the observation group were longer than those in the control group, while the α angle, MA, CI, MARAA and MARADP values were lower (P<0.05).
Conclusion: Ticagrelor can improve antiplatelet treatment for patients with AMI during the perioperative period of emergency PCI.
Peiyuan H, Jingang Y, Haiyan X, et al (2016). The Comparison of the Outcomes be-tween Primary PCI, Fibrinolysis, and No Reperfusion in Patients ≥ 75 Years Old with ST-Segment Elevation Myocardial Infarction: Results from the Chinese Acute Myocardial Infarction (CAMI) Reg-istry. PLoS One, 11(11): e0165672.
Liu Y, Yin H, Jiang Y, Xue M, Guo C, Shi D, Chen K (2013). Correlation between Platelet Gelsolin and Platelet Activa-tion Level in Acute Myocardial Infarc-tion Rats and Intervention Effect of Ef-fective Components of Chuanxiong Rhi-zome and Red Peony Root. Evid Based Complement Alternat Med, 2013: 985746.
Kimmelstiel C1, Zhang P, Kapur NK et al (2011). Bivalirudin is a Dual Inhibitor of Thrombin and Collagen-Dependent Platelet Activation in Patients Undergoing Percutaneous Coronary In-tervention. Circ Cardiovasc Interv, 4(2): 171–179.
Jia LX, Qi GM, Liu O, Li TT, Yang M, Cui W, Zhang WM, Qi YF, Du J (2013). In-hibition of Platelet Activa-tion by Clopidogrel Prevents Hyperten-sion-Induced Cardiac Inflammation and Fibrosis. Cardiovasc Drugs Ther, 27(6): 521–530.
Husted S, Boersma E (2016). Case Study: Ticagrelor in PLATO and Prasugrel in TRITON-TIMI 38 and TRILOGY-ACS Trials in Patients With Acute Coronary Syndromes. Am J Ther, 23(6): e1876–e1889.
Ray S (2014). Clopidogrel resistance: The way forward. Indian Heart J, 66(5): 530–534.
Lau YC, Xiong Q, Ranjit P, Lip GYH, Blann AD (2016). Laboratory assessment of anti-thrombotic therapy in heart fail-ure, atrial fibrillation and coronary artery disease: insights using thrombelas-tography and a micro-titre plate assay of thrombogenesis and fibrinolysis. J Thromb Thrombolysis, 42(2): 233–244.
Dobesh PP, Oestreich JH (2014). Ticagrelor: Pharmacokinetics, Pharmacodynamics, Clinical Efficacy, and Safety. Pharmacother-apy, 34(10): 1077–1090.
Toma N (2010). Randomized double-blind assessment of the ONSET and OFFSET of the antiplatelet effects of Ticagre-lor versus Clopidogrel in patients with stable coronary artery disease. The-ONSET/OFFSET study. Maedica (Bu-char), 5(1): 75–76.
Silber S (2011). Immediate and Long-Term Therapy of Patients with Acute Coronary Syndromes with Thienopyridines. Cur-rent Status According to the Lat-est European Society of Cardiology(ESC) Guidelines. Rambam Maimonides Med J, 2(3): e0056.
Koul S, Andell P, Martinsson A et al (2014). A pharmacodynamic comparison of 5 anti-platelet protocols in patients with ST-elevation myocardial infarc-tion undergoing primary PCI. BMC Cardi-ovasc Disord, 14: 189.
Files | ||
Issue | Vol 47 No 7 (2018) | |
Section | Original Article(s) | |
Keywords | ||
Ticagrelor Clopidogrel resistance Acute myocardial infarction Thrombelastogram Major adverse cardiac events |
Rights and permissions | |
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |