Efficacy And The Risk Of Bleeding By Ticagrelor In Patients With Acute Non ST Segment Elevation Myocardial Infarction And Diabetes Mellitus

Objective: To observe the efficacy and the risk of bleeding by ticagrelor in patients with acute non ST segment elevation myocardial infarction and diabetes mellitus undergoing percutaneous coronary intervention(PCI).Methods: One hundred and twenty-three patients(82males,41females),suffered from NSTEMI and diabetes mellitus undergoing PCI in the Second Hospital of Hebei Medical University from Feb 2014 to Jan 2015,were selected for this study.All the patients were randomly divided into two groups: clopidogrel group(n=61)and ticagrelor group(n=62).Clopidogrel group was given clopidogrel(300 mg)at admission,then clopidogrel 75 mg qd.Ticagrelor group was given ticagrelor(180 mg)at admission,then ticagrelor 90 mg bid.Each group was given aspirin(300 mg)at admission,then aspirin 100 mg qd.Recording and comparing the differences of baseline clinical characteristics.Recording platelet inhibition rate by using thrombelastography(TEG)at admission and 7 days,1month,6 months after PCI,recording left ventricular ejection fraction(LVEF)at admission and 1 month,6 months after PCI,recording platelet count at admission and 6 months after PCI,the major adverse cardiovascular events(MACE)and adverse reaction events in a period of 6 months after PCI,bleeding events in a period of 6 month between clopidogrel group and ticagrelor group.The package of SPSS 21.0 was used for analyzing data,and P < 0.05 was considered statistically significant.Results:1 There was no significant difference between the two groups in sex,age,smoking history,hypertension history,family history,hemoglobin,low density lipoprotein levels,creatinine,glycated hemoglobin level,GRACE scores,CRUSADE scores(P>0.05).2 The ADP inhibition rate: the ADP inhibition rate in clopidogrel group and ticagrelor group was 16.64±5.90 vs 15.96±6.02 separately at admission,the dates was not significantly different between two groups(P>0.05).Seven days after PCI clopidogrel group and ticagrelor group was 49.67±10.03 vs 60.32±9.94 separately(P<0.05).One month after PCI,significant difference was observed between clopidogrel group(49.95±9.74)and ticagrelor group(58.24±10.51)(P < 0.05).Six months after PCI clopidogrel group and ticagrelor group was 52.42±10.30 vs 61.67±9.75 separately(P<0.05).The two groups had significant increase in ADP inhibition rate from baseline on the 7 days,1 month,6 months post-operation(all P<0.05).3 Bleeding events: In general,The incidence rates of total bleeding were different in the 6 months between clopidogrel group and ticagrelor group(3.28% vs 17.74%,P<0.05).There was no major bleeding case was observed in two groups(P>0.05).4 LVEF(%): It was 47.51±7.63 in clopidogrel group at admission,whereas 48.79±7.64 in ticagrelor group,there were no significant difference between the two groups(P>0.05).One month after PCI,no significant difference was observed between clopidogrel group(50.17 ± 6.78)and ticagrelor group(52.09±7.43)(P>0.05).Six months after PCI,the level of LVEF in ticagrelor group(54.76±7.37)was significantly higher than that in clopidogrel group(52.00±8.02)(P<0.05).The LVEF after PCI in both groups were significantly better than that at admission(P<0.05).5 MACE and adverse reaction events: The incidence of MACE is lower in ticagrelor group than clopidogrel group within 6 months,the result is significantly different(P<0.05).There was 6 dyspnea cases in ticagrelor group,which was significantly higher than that in clopidogrel group(P<0.05).6 Platelet count: There was no significant difference between two groups at admission and six months after PCI(P>0.05).Platelet count did not decline six months after PCI in ticagrelor group(P>0.05).Conclusion:1 Ticagrelor showed a better antiplatelet effect than clopidogrel.2 Compared with clopidogrel,ticagrelor could increase the incidence rate of total bleeding,but did not increase the incidence rate of major bleeding.3 Ticagrelor may be beneficial to cardiac function and could significantly reduce major adverse cardiovascular events within six months after PCI.