Efficacy and Bleeding Risks of Ticagrelor Replacement for Treating Elderly Acute Coronary Syndrome Patients With Low Response to Clopidogrel
10.3969/j.issn.1000-3614.2017.11.008
- VernacularTitle:氯吡格雷低反应的老年急性冠状动脉综合征患者换用替格瑞洛后的疗效及出血危险因素
- Author:
dan Hong JIA
1
;
le Xi BI
;
hua Qiang GUO
;
ting Ting SONG
;
sheng Qing WANG
;
liang Hong CONG
;
Rui CUI
;
Jie CHEN
;
Li LIU
Author Information
1. 秦皇岛市第一医院 心内科
- Keywords:
Acute coronary syndrome;
Platelet aggregation inhibitiors;
Bleeding
- From:
Chinese Circulation Journal
2017;32(11):1075-1079
- CountryChina
- Language:Chinese
-
Abstract:
Objective: To observe the efficacy of ticagrelor for treating elderly acute coronary syndrome (ACS) patients with elective PCI and having low response to clopidogrel; to explore the bleeding risks induced by ticagrelor replacement. Methods: A total of 945 ACS patients ≥ 65 years treated in our hospital from 2014-01 to 2017-01 were enrolled. All patients received aspirin and clopidogrel dual antiplatelet therapy (DAPT), thrombelastography (TEG) was used to detect platelet inhibition rate when DAPT ≥ 5 days. Based on platelet inhibition rate, the patients were divided into 2 groups:Ticagrelor replacement group, n=293 patients with low response to clopidogrel and switched to ticagrelor treatment, when adjusted DAPT ≥ 5 days, platelet inhibition rate was rechecked to compare the changes; Clopidogrel group, the patients were continuously treated by the same medication, n=652. The patients were followed-up for 3 months, bleeding events were evaluated by TIMI criteria and compared between 2 groups. Risk factors of ticagrelor induced bleeding were assessed by multivariate Logistic regression analysis. Results: Platelet inhibition rates in Ticagrelor replacement group were (51.70±42.90) %, (48.99±41.85) % and (55.08±25.70) % at (5-7) d, (8-14) d and (15-90) d ticagrelor treatment, which were higher than previous clopidogrel treatment (14.50±24.15) %, all P<0.05. The incidences of severe bleeding events were similar between 2 groups, P=0.96. Multivariate Logistic regression analysis presented that female (OR=4.329, P=0.000), low body weight (OR=0.817, P=0.039) and elevated fasting blood glucose (OR=1.251, P=0.028) were the independent risk factors for bleeding complication in ticagrelor treated elderly ACS patients. Conclusion: Compared with clopidogrel, ticagrelor may faster and more effectively inhibit platelet aggregation without increasing severe bleeding; female, low body weight and elevated fasting blood glucose were the independent risk factors for bleeding complication in ticagrelor treated elderly ACS patients with elective PCI.
