Efficacy and loading dose analysis of ticagrelor in acute coronary syndrome patients with low on-clopidogrel platelet reactivity and its influence on prognosis

Objective To evaluate the therapeutic efficacy and influence on the prognosis of ticagrelor in acute coronary syndrome (ACS) patients with low on-clopidogrel platelet reactivity,and analyze its loading dose. Methods A total of 328 cases of ACS patients undergoing percutaneous coronary intervention (PCI) and receiving clopidogrel 75 mg/d treatment in our hospital between September,2013 and April,2016 were enrolled into this study.The platelet aggregation was detected by thrombelastography and 110 patients with low on-clopidogrel platelet reactivity were selected.They were randomly assigned into ticagrelor group (n=54) and clopidogrel group (n=56).The clopidogrel group was continually administrated with clopidogrel 75 mg/d,while the ticagrelor group with ticagrelor 90 mg,2 times/d.The incidence of major adverse cardiac and cerebrovascular events,adverse reactions,uric acid levels and platelet aggregation after the treatment were compared between the two groups. Results After the treatment,the platelet aggregation rate on d3,d7 and d30 in ticagrelor group were significantly lower than those in the clopidogrel group,the difference was significant (P<0.05);The incidence of UAP,AMI,TIA,heart failure and cerebrovascular accidents in the ticagrelor group was significantly lower than those in the clopidogrel group,the difference was significant (P<0.05);The incidence of cardiogenic mortality,bleeding and stroke in the ticagrelor group were significantly lower than those in the clopidogrel group,the difference was significant (P<0.05);Three days and 30 days after the discharge,uric acid levels in the clopidogrel group was significantly higher than that in the ticagrelor group,the incidence of gout in the ticagrelor group (3.51%) was lower than that in the clopidogrel group (18.51%),the difference was significant. Conclusion Ticagrelor therapy for ACS patients with low on-clopidogrel platelet reactivity after PCI can improve the platelet aggregation,reduce the incidence of adverse events,the curative effect is significant.