Shi Jing, He Meijiao, Wang Wennan, Liu Guangzhong, Zhang Haiyu, Sun Danghui, Li Jianqiang, Mu Hongyuan, Xu Minglu, Zhao Chenyang, Wang Jiayu, Zhang Chongyang, Cang Hai, Zhao Shiqi, Zhang Zhiren, Li Yue
Department of Cardiology, the First Affiliated Hospital, Harbin Medical University , Harbin, China.
Institute of Metabolic Disease, Heilongjiang Academy of Medical Science , Harbin, China.
Platelets. 2021 Jan 2;32(1):120-129. doi: 10.1080/09537104.2020.1732328. Epub 2020 Feb 23.
Current guidelines favor dual anti-platelet therapy with ticagrelor 90 mg BID (T90BID) over clopidogrel 75 mg QD (C75QD) in addition to aspirin for acute coronary syndrome. However, an increased risk of ticagrelor-related adverse events prompted the evaluation of low-dose regimens. This study (NCT03381742) retrospectively analyzed the data from 11 hospitals on 3,043 patients with coronary artery disease, who received C75QD, T90BID, ticagrelor 45 mg BID (T45BID), or ticagrelor 90 mg QD (T90QD). Compared with C75QD, both T45BID and T90QD showed significantly higher inhibition of platelet aggregation ( < .0001) and lower platelet-fibrin clot strength ( < .0001) induced by adenosine diphosphate. Furthermore, compared with T90BID, two low-dose regimens had a much lower minor bleeding rate and a significantly higher proportion of patients within the therapeutic window for P2Y receptor reactivity. There were no significant differences between T45BID and T90QD in the trough plasma concentrations of ticagrelor and its active metabolite. Similar efficacy and safety outcomes were observed in the propensity score-matched analysis. In conclusion, the low-dose ticagrelor regimen, either T45BID or T90QD, may provide a more attractive benefit-risk profile than C75QD or T90BID.
目前的指南支持在阿司匹林基础上，使用替格瑞洛90毫克每日两次（T90BID）进行双重抗血小板治疗，而非氯吡格雷75毫克每日一次（C75QD），用于急性冠状动脉综合征。然而，替格瑞洛相关不良事件风险的增加促使人们对低剂量方案进行评估。本研究（NCT03381742）回顾性分析了11家医院3043例冠心病患者的数据，这些患者接受了C75QD、T90BID、替格瑞洛45毫克每日两次（T45BID）或替格瑞洛90毫克每日一次（T90QD）治疗。与C75QD相比，T45BID和T90QD对二磷酸腺苷诱导的血小板聚集抑制作用均显著更高（<0.0001），血小板 - 纤维蛋白凝块强度更低（<0.0001）。此外，与T90BID相比，两种低剂量方案的轻微出血率更低，且处于P2Y受体反应性治疗窗内的患者比例显著更高。替格瑞洛及其活性代谢产物的谷浓度在T45BID和T90QD之间无显著差异。倾向评分匹配分析中观察到了相似的疗效和安全性结果。总之，低剂量替格瑞洛方案，即T45BID或T90QD，可能比C75QD或T90BID具有更具吸引力的效益风险比。
