Evaluation Of Antiplatelet Effects And Safety Of Intraoperative Administration Of Ticagrelor Versus Clopidogrel In Patients Undergoing "One-stop' Hybrid Coronary Revascularization

Background and objectives One-stop hybrid coronary revascularization(HCR)is an alternative approach to left main and/or multivessel coronary artery disease.The one-stop HCR includes left internal mammary artery(LIMA)anastomosis to the left anterior descending coronary artey(LAD),typically via a minimally invasive approach,and simultaneously percutaneous coronary intervention(PCI)for the remaining(non-LAD)lesions.In theory,HCR reduce surgical trauma while preserving long-term survival and minimizing adverse cardiovascular events.However,one big challenge of HCR is balancing the risk of perioperative bleeding with that of stent thrombosis.The optimal antiplatelet regimen of the one-stop hybrid procedure still uncertain.This study is aimed to evaluate the antiplatelet effects and safety of clopidogrel and ticagrelor in patients during One-stop HCR.Methods This is a single-center,open-labels randomized,prospective study.60 Patients undergoing one-stop HCR was randomized equally(ratio 1:1)to received either clopidogrel(300mg loading dose[LD],75 mg/day),or to received ticagrelor(90 mg LD,90 mg twice daily)after confirmation of LIMA-LAD graft patency.All patients treated with concomitant ASA 100mg once daily during the treatment period.Platelet reaction units(PRU)was assessed by Verify NowTM P2Y12 assay at 30min,lhour,2hour,6hour,24hour after loading dose.The platelet count was recorded in both groups from preoperation to three days after operation.Thoracic cavity drainage 24hours and 72hours after operation was recorded,as well as bleeding and the use of blood products.Two groups,major adverse cardiac or cerebrovascular events(MACCE)rates within 3 months follow-up were compared.Results Ticagrelor produced further suppression of platelet aggregation in patients undergoing HCR procedure from 2h after LD(PRU were 313.17±61.161 for clopidogrel and 271±51.575 for ticagrelor(p<0.05)).Patients in ticagrelor group achieve a proper average PRU value(<235)untill 6hour after HCR procedure.The average PRU value was above 235 platelet reaction units threshold until 24hours after procedure in clopidogrel group.The platelet count showed a decreased tendency in the early period after both groups probably because of surgery.However,there were comparable between two groups.24hours(P=0.131)and 72hours(P=0.264)thoracic cavity drainage were comparable between two groups.The use of blood products,bleeding and MACCE were comparable between two groups.Conclusions Tieagrelor achieves greater antiplatelet effect than clopidogrel in patients undergoing HCR procedure,early after treatment.There were no significant difference of thoracic cavity,major and minor bleeding and MACCE between two groups.Ticagrelor might be more effective antiplatelet choice than clopidogrel in one-stop HCR and without increasing bleeding risk.