A Comparative Study Of Safety And Clinical Efficacy Between Ticagrelor And Clopidogrel In The Treatment Of Acute Coronary Syndrome With Thrombocytopenia

Objective:To compare the safety and clinical efficacy between Ticagrelor and Clopidogrel in the treatment of acute coronary syndrome(ACS)with thrombocytopenia.Methods:A retrospective analysis was performed on 79 ACS patients with thrombo-cytopenia hospitalized in the Second Affiliated Hospital of Nanchang University from January 2018 to December 2019.All patients had platelet count<100×10~9/L before or at admission,and underwent percutaneous coronary intervention after admission.All the patients were divided into Ticagrelor group(n=50 cases)and Clopidogrel group(n=29 cases)according to the inhibition of P2Y12 receptor after surgery.General clinical baseline data,examination data and surgical treatment data of all the patients were collected,and patients were followed up by outpatient service or telephone at 1,3,6,12 and 24 months after discharge.The study endpoints were hemorrhage,all-cause death,myocardial infarction,target lesions revascularization,stent thrombosis,coronary artery bypass grafting(CABG)and ischemic stroke.The major hemorrhage defined as BARC type 2,3,or 5,and minor hemorrhage as BARC type 1.SPSS 23.0software was used for statistical analysis,Kaplan-Meier survival curve was drawn to calculate the 2-year event-free survival rate,and Log Rank test was used to compare the survival rate of the two groups.Results:(1)Platelet count was(80.58±12.51)×10~9/L in Ticagrelor group and(76.83±21.38)×10~9/L in Clopidogrel group,differences between the two groups has no statistical significance(P=0.393).(2)There were no statistically significant differe-nces between the two groups in general clinical baseline data,examination results,and surgical treatment data(P>0.05).(3)The patients were followed up for 1-24months after discharge,with a median follow-up of 10 months.During the follow-up period,a total of 6 cases of all-cause death,1 case of target vessel revascularization,1case of CABG,and 1 case of BARC type 1 hemorrhage occurred in Ticagrelor group,and 4 cases of all-cause death,1 case of ischemic stroke in Clopidogrel group.There was no significant difference in the incidence of bleeding and other end point events between the two groups(P>0.05).(4)Kaplan-Meier curve was drawn,and the 2-year event-free survival rates of patients in Ticagrelor group and Clopidogrel group were 86.4%and 85.8%,and the result of Log Rank test was P=0.747.The results suggesting that there should be no significant difference in the survival rates of patients treated with the two drugs.Conclusion:Compared with Clopidogrel in the treatment of ACS with thrombocytopenia,Ticagrelor has the same safety and clinical efficacy.