Wu Xi, Liu Gang, Lu Jie, Zheng Xin-Xin, Cui Jin-Gang, Zhao Xue-Yan, Huang Xiao-Hong
Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College.
Int Heart J. 2017 Apr 6;58(2):167-173. doi: 10.1536/ihj.16-222. Epub 2017 Mar 17.
Previous studies have identified high on treatment platelet reactivity (HTPR) as a potent factor predicting ischemic events for patients with coronary heart disease. We assessed the efficacy and safety of ticagrelor (90 mg twice-daily) and double-dose of clopidogrel (150 mg once-daily) among Chinese patients for elective percutaneous coronary intervention. We enrolled 40 patients with HTPR from among 317 patients with non-ST-segment elevation acute coronary syndromes after a successful elective percutaneous coronary intervention (PCI). Platelet reactivity was measured by VerifyNow P2Y12 assay. Platelet reactivity was significantly lower for both groups when compared with baseline platelet reactivity after medication adjustment (all P < 0.001). The mean platelet reactivity units (PRU) was significantly lower for the ticagrelor group compared with that of the clopidogrel group over time (all P < 0.001). The differences in the rate of sustained HTPR at different time points between the two groups were significant (2 hours: 0% versus 60%; 8 hours: 5.6% versus 50%; 24 hours: 5.9% versus 43.8%, all P < 0.05). Genetic variation of CYP2C19*2 had no impact on PRU means or rate of HTPR in the ticagrelor group (P > 0.05). During the 30-day follow-up, no MACE occurred in any patient, and the overall risk of bleeding showed no difference between the two groups (35% versus 21%, P = 0.48). Our results suggest that ticagrelor may achieve a more rapid and greater platelet inhibition than double-dose clopidogrel. Further studies are still needed to assess the differences in efficacy and safety between ticagrelor and double-dose clopidogrel administration for Chinese patients post elective PCI.
既往研究已将治疗中高血小板反应性（HTPR）确定为预测冠心病患者缺血事件的一个重要因素。我们评估了替格瑞洛（每日两次，每次90毫克）和双倍剂量氯吡格雷（每日一次，每次150毫克）对中国择期经皮冠状动脉介入治疗患者的疗效和安全性。我们从317例非ST段抬高型急性冠状动脉综合征患者中，选取了40例在择期经皮冠状动脉介入治疗（PCI）成功后出现HTPR的患者。通过VerifyNow P2Y12分析测定血小板反应性。药物调整后，两组的血小板反应性与基线血小板反应性相比均显著降低（所有P<0.001）。随着时间推移，替格瑞洛组的平均血小板反应性单位（PRU）显著低于氯吡格雷组（所有P<0.001）。两组在不同时间点持续HTPR发生率的差异有统计学意义（2小时：0%对60%；8小时：5.6%对50%；24小时：5.9%对43.8%，所有P<0.05）。CYP2C19*2基因变异对替格瑞洛组的PRU均值或HTPR发生率无影响（P>0.05）。在30天随访期间，所有患者均未发生主要不良心血管事件（MACE），两组的总体出血风险无差异（35%对21%，P=0.48）。我们的结果表明，替格瑞洛可能比双倍剂量氯吡格雷实现更快、更强的血小板抑制作用。仍需进一步研究评估替格瑞洛和双倍剂量氯吡格雷对中国择期PCI术后患者疗效和安全性的差异。
