Study On Antithrombotic Strategy Selection In Patients With Special Type Of Coronary Heart Disease After

Antithrombotic strategy and prognostic study for post-PCI patients with atrial fibrillation.Background:With the aging of population and rising of the prevalence rate, the number of coronary heart disease (CHD) patients undergoing percutaneous coronary intervention increasing shapely. Atrial fibrillation (AF) is the most common type of arrhythmia. AF and CHD share the same risk factors, thus there isn’t rarely seen that many patients combine both conditions in clinical practice.Methods:From 1 Jan.2012 to 31 Dec.2014,570 underwent PCI procedures with non-valvular AF patients were enrolled in this study. According to the CHADS2 Score system and anticoagulant therapy with/without Warfarin divide those patients into four groups. Follow up 15 months through clinical visits or phone. Comparison the outcomes including MACCE、ischemic events and bleeding events among 4 groups.Results:Comparing with the low stroke risk group, high stroke risk group has worse outcomes, more MACCE(p<0.001, HR=2.667,95%CI[1.535,4.635])and ischemia events(p=0.013, HR=2.080,95%CI[1.167,3.709]).Compared to the low stroke risk without warfarin group, the high stroke risk without warfarin group has more events. HR=2.985, P=0.001,95%CI[1.532,5.816] in MACCE, and HR=2.068, P=0.026,95%CI[1.090,3.925] in ischemia. Whereas, the outcomes shows no statistical difference in high stroke risk with warfarin group、low stroke risk with warfarin and low stroke risk without warfarin(all their P value>0.05). The major bleeding in warfarin groups seems higher than in non-warfarin groups, nevertheless the difference doesn’t have the statistical significant. Warfarin could significantly increase the minor bleeding events either in low risk stroke group(OR=4.458, P<0.001,95%CI[1.934,10.277]) or high risk stroke group (OR=4.155, P=0.002,95%[1.717,10.055])Conclusion:Warfarin shows its superiority of preventing MACCE and ischemia events in high stroke risk patients, however its might caught more bleeding as the same.Effectiveness of Ticagrelor on Platelet Inhibition in Post-PCI Clopidogrel Low-Responders under Intensive antiplatelet therapy.Background:The Clopidogrel low responders have poor inhibition platelet aggregation (IPA) and worse clinical outcomes. Some intensive antiplatelet therapy might have beneficial effects on platelet inhibition in these patients. Ticagrelor achieved more rapid and potent platelet inhibition so is superior to Clopidogrel. This study aims to observe whether Ticagrelor is superior in improving laboratory index effect of antiplatelet agents over intensive antiplatelet therapy in Clopidogrel low-responders.Methods:From August 2012 to May 2014,205 post-PCI patients recognized as Clopidogrel low responders who were identified by thrombelastogram in Fuwai Hospital. Clopidogrel low responders was defined as ADP-induced IPA of less than 30% and MAADP more than 47mm. all of the them received Intensive therapy (Double-dose Clopidogrel or triple antiplatelet therapy containing Cilostazol based on aspirin 100mg QD), and 10 of them (4.88%) switched to Ticagrelor after average 2.2 months Intensive therapy. We followed up the thrombelastogram (TEG) results after 1-month therapy with Ticagrelor, and compared effects on improving the laboratory-index of platelet function under antiplatelet therapy with the continuous Intensive therapy.Results:10 patients switched to taking Ticagrelor and 195 patients maintained Intensive therapy strategy. The mean duration of Intensive therapy before switch to Ticagrelor was 2.2 months. The TEG was tested 1 month after switching to Ticagrelor or 3 months continuous Intensive therapy. The baseline ADP-induced IPA or MAADP showed no difference in both two groups. Compared with baseline, the ADP-induced IPA was improved both in Ticagrelor and Intensive therapy, (8.35±9.29)% vs. (52.25±35.91)% in Ticagrelor (p=0.017) and (11.33±9.16)% vs. (20.26±20.94)% in Intensive therapy (p<0.001). The MAADP (ADP-induced maximal amplitude) declined in two groups,54.3±7.2 vs.36.0±19.0 in Ticagrelor (p=0.017) and 55.6±5.7 vs.48.9±11.7 in Intensive therapy (p<0.001). The ADP-induced IPA was (8.35±9.29)% vs. (11.33±9.16)%(Ticagrelor vs. Intensive therapy, p=0.323). The MAADP were 54.3±7.2 vs.55.6±5.7(Ticagrelor vs. Intensive therapy, p=0.519). While compared to the Intensive therapy, the Ticagrelor achieved a larger degree of improvement in TEG-index. ADP-induced IPA was (52.25±35.91)% vs. (20.26±20.94)%(Ticagrelor vs. Intensive therapy, p=0.002). MAADP were 36.0±19.0 vs.48.9±11.7 (Ticagrelor vs. Intensive therapy, p=0.028). The exact value of ADP-induced IPA in Ticagrelor was 35.3%(95% CI [19.8% to 50.9%]) (p<0.001) higher than Intensive therapy, and the exact value of MAADP was 13.8(95% CI [5.4 to 22.3])(p=0.002) lower.Conclusion:Although both Intensive therapy and Ticagrelor could improve the TEG-index of platelet function under antiplatelet therapy in Clopidogrel low responders, Ticagrelor achieved a larger degree of improvement in TEG-index compared to Intensive therapy. Ticagrelor seems to be an adequate option to Clopidogrel low responders. However we need the RCT trials to confirm the hypothesis.