Pre-PCI medication using clopidogrel and ticagrelor in the treatment of patients with acute myocardial infarction.

OBJECTIVE

This study aimed to compare preoperative treatment using clopidogrel and ticagrelor for patients with acute myocardial infarction (AMI) undergoing emergent percutaneous coronary intervention (PCI), and to investigate the efficacy and safety of these medications in the management of AMI.

PATIENTS AND METHODS

Between February 2013 and December 2014, 74 patients with AMI admitted for emergent PCI therapy were included in the study and randomly divided into two groups: study group and control group. Patients in the study group received different pre-PCI treatment with a loading dose of 180 mg ticagrelor, and those in the control group received treatments with a loading dose of 600 mg clopidogrel. After PCI procedure, all patients were orally administered 75 mg clopidogrel once a day for maintenance therapy, and patients were monitored for one week at the hospital and further followed up for one month Platelet aggregation rates (PAR) of each patient was measured before medication, at 30 min, 2h, 24h and one week after medication, respectively. PAR, thrombolysis in myocardial infarction (TIMI) flow, clinical outcomes and adverse reactions were compared between groups.

RESULTS

No significant differences were observed in PAR before treatment between groups (p>0.05), whereas PARs were significantly different after treatment between groups (p<0.05), with the efficacy of medications peaking at 2h after the treatment. In addition, PARs were significantly different between different time points after treatment (p<0.05). Evaluation of TIMI flow grade showed that in study group, 6 patients (16.22%) were grade 2 and 31 (83.78%) were grade 3 for the study group; for the control group, 11 patients (27.73%) were grade 2 and 26 (72.27%) were grade 3. No significant differences were observed in TIMI flow grades between different groups (p>0.05). No recurrence of the disease was observed, but one case (2.70%) of mucosal bleeding in the nasal cavity and four cases (10.81%) of vomiting were found in the study group. However, in the control group, four patients (10.81%) presented with recurrent disease, six patients (16.22%) experienced mucosal bleeding in the nasal cavity and 11 patients (29.73%) vomited. Significant differences were observed in the incidence of adverse events between different groups (p<0.05).

CONCLUSIONS

Compared with 600 mg clopidogrel, a loading dose of 180 mg ticagrelor could effectively inhibit platelet reactivity at the early stage of AMI, resulting in more favorable clinical outcomes and lower occurrence of adverse events and, thereby, can be used in clinical practice.