Abstract:

Objective To explore the clinical efficacy of ticagrelor sequential therapy on clopidogrel resistance after application of percutaneous coronary intervention (PCI) to patients with acute coronary syndrome (ACS). Methods On the 7th day after PCI, 102 cases of ACS were screened with the VerifyNow-P2Y12 system and were randomly assigned to two groups. The treatment group (n=51) received the ticagrelor sequential therapy, which administrated bayaspirin (100 mg/d) plus ticagrelor (loading dose of 180 mg, then 90 mg each time, bis in die) for 3 months. The control group (n=51) received intensive treatment, which administrated bayaspirin (100 mg/d) plus clopidogrel (150 mg/d) for 3 months. Both groups received bayaspirin (100 mg/d) plus clopidogrel (75 mg/d) for 9 months after 3 months. VerifyNow system was used to determine the residual activity of platelets (in PRU) before treatment and 7 d, 1 month, and 3 months after treatment. Ischemic events, bleeding events, and adverse reactions of drugs within 12 months were followed up. Results The difference in PRU between two groups before treatment was not statistically significant but comparable. The PRU in the treatment group was lower than that in the control group 7 d, 1 month, and 3 months after treatment (P=0.016, P=0.000, and P=0.000). The incidence of ischemic events in the treatment group was lower than that in the control group (χ2=4.993, P=0.026). The difference in the incidence of minor bleeding events between two groups was not statistically significant (χ2=0.614, P=0.450). The difference in the incidence of adverse reactions between two groups was not statistically significant (χ2=0.444,P=0.506). Conclusion Ticagrelor sequential therapy can reduce the PRU in ACS patients with clopidogrel resistance, improve clopidogrel resistance, and decrease the incidence of ischemic events without increasing the risk of bleeding.

Key words: ticagrelor; , sequential therapy, acute coronary syndrome; , clopidogrel resistance