Background There is great debate on the possible adverse interaction between proton pump inhibitors （PPIs） and clopidogrel. In ad- dition, whether the use of PPIs affects the clinical efficacy of ticagrelor remains ...Background There is great debate on the possible adverse interaction between proton pump inhibitors （PPIs） and clopidogrel. In ad- dition, whether the use of PPIs affects the clinical efficacy of ticagrelor remains less known. We aimed to determine the impact of concomi- tant administration of PPIs and clopidogrel or ticagrelor on clinical outcomes in patients with acute coronary syndrome （ACS） after percuta- neous coronary intervention （PCI）. Methods We retrospectively analyzed data fi＇om a ＂real world＂, international, multi-center registry between 2003 and 2014 （n = 15,401） and assessed the impact of concomitant administration of PPIs and clopidogrel or ticagrelor on 1-year composite primary endpoint （all-cause death, re-infarction, or severe bleeding） in patients with ACS after PCI. Results Of 9429 patients in the final cohort, 54.8% （n = 5165） was prescribed a PPI at discharge. Patients receiving a PPI were older, more often female, and were more likely to have comorbidities. No association was observed between PPI use and the primary endpoint for patients receiving clopidogrel （ad- justed HR： 1.036; 95% CI： 0.903-1.189） or ticagrelor （adjusted HR： 2.320; 95% CI： 0.875-45.151） （Pinteraction = 0.2004）. Similarly, use of a PPI was not associated with increased risk of all-cause death, re-infarction, or a decreased risk of severe bleeding for patients treated with either clopidogrel or ticagrelor. Conclusions In patients with ACS following PCI, concomitant use of PPIs was not associated with in- creased risk of adverse outcomes in patients receiving either clopidogrel or ticagrelor. Our findings indicate it is reasonable to use a PPI in combination with clopidogrel or ticagrelor, especially in patients with a higher risk of gastrointestinal bleeding.展开更多
We performed a meta-analysis of randomized controlled trials（RCTs） to investigate the efficacy and safety of ticagrelor（TIC） vs. clopidogrel（CLO） in patients undergoing percutaneous coronary intervention（PCI）....We performed a meta-analysis of randomized controlled trials（RCTs） to investigate the efficacy and safety of ticagrelor（TIC） vs. clopidogrel（CLO） in patients undergoing percutaneous coronary intervention（PCI）. In Jun 2016, a literature search was started and all the studies were conducted from 2010 to 2015. We systematically searched the literature through the MEDLINE database, Cochrane library, and EMBASE database. Quality assessments were evaluated with Jadad quality scale. Data were extracted considering the characteristics of efficacy and safety designs. Six RCTs enrolling 26 244 participants and satisfying the inclusion criteria were finally analyzed. There was a significant decrease of all-cause mortality（MD=0.83, 95%CI=0.74–0.93, P=0.001） and myocardial infarction（MI）（MD=0.78, 95%CI=0.70–0.88, P=0.000）. There were no significant differences in stroke（MD=1.34, 95%CI=0.99–1.79, P=0.06）, total bleeding（MD=0.97, 95%CI=0.84–1.12, P=0.66）, minor or major bleeding（MD=1.06, 95%CI=0.94–1.19, P=0.35） in patients undergoing PCI after treatment with TIC vs. CLO. TIC could be more significant in decreasing all-cause mortality and MI than CLO, but there were no significant differences between TIC and CLO in inhibiting stroke, major bleeding, major or minor bleeding in patients undergoing PCI.展开更多
Ticagrelor is a potent,direct P2Y12 antagonist with rapid onset of action and intense platelet inhibition,indicated in patients with acute coronary syndromes(ACS).This drug is usually well tolerated,but some patients ...Ticagrelor is a potent,direct P2Y12 antagonist with rapid onset of action and intense platelet inhibition,indicated in patients with acute coronary syndromes(ACS).This drug is usually well tolerated,but some patients experience serious adverse effects:Major bleeding;gastrointestinal disturbances;dyspnoea;ventricular pauses > 3 s.Given the unexpected high incidence of bradyarrhythmias,a PLATO substudy monitored this side effect,showing that ticagrelor was associated with an increase in the rate of sinus bradycardia and sinus arrest compared to clopidogrel.This side effect was usually transient,asymptomatic and not associated with higher incidence of severe atrioventricular(AV) block or pacemaker needs.A panel of experts from Food and Drug Administration did not consider bradyarrhythmias a serious problem in clinical practice and,accordingly,current labeling of the drug does not give any precaution or contraindication regarding this issue.However,recently some articles have described ACS patients with high-degree,life-threatening,AV block requiring drug discontinuation and,in some cases,pacemaker implantation.In this paper,we describe and discuss five published case reports of severe AV block following ticagrelor therapy and two other cases managed in our Hospital.The analysis of literature suggests that,although rarely,ticagrelor can be associated with lifethreatening AV block.Caution and careful monitoring are required especially in patients with already compromised conduction system and/or treated with AV blocking agents.Future studies,with long-term rhythm monitoring,would help to define the outcome of patients at higher risk of developing this complication.展开更多
Background Ticagrelor provides enhanced antiplatelet efficacy but increased risk of bleeding and dyspnea. This study aimed to display the relationship between ADP-induced platelet-fibrin clot strength （MAADP） and cl...Background Ticagrelor provides enhanced antiplatelet efficacy but increased risk of bleeding and dyspnea. This study aimed to display the relationship between ADP-induced platelet-fibrin clot strength （MAADP） and clinical outcomes in acute coronary syndrome （ACS） patients treated by ticagrelor. Methods Consecutive Chinese-Han patients with ACS who received maintenance dose ofticagrelor on top of aspirin were recruited. After 5-day ticagrelor maintenance treatment, MAADP measured by thrombelastography （TEG） were recorded for the evaluation of ticagrelor anti-platelet reactivity. Pre-specified cutoffs of MAADP 〉 47 mm for high on-treatment platelet reactivity （HTPR） and MAADP 〈 31 mm for low on-treatment platelet reactivity （LTPR） were applied for evaluation. The occurrences of primary ischemic cardiovascular events （including a composite of cardiac death, non-fatal myocardial infarction and stroke）, the Thrombolysis in Myocardial Infarction （TIMI） defined bleeding events, and ticagrelor related dyspnea were recorded after a follow-up of three months. Results Overall, 176 ACS patients （Male： 79.55%, Age： 59.91 ±10.54 years） under ticagrelor maintenance treatment were recruited. The value of MAADP ranged from 4.80% to 72.90% （21.27% ± 12.07% on average）, with the distribution higher skewed towards the lower values. Using the pre-specific cutoffs for HTPR and LTPR, seven patients （3.98%） were identified as HTPR and 144 patients （81.82%） as LTPR. After a follow-up of three months in 172 patients, major cardiovascular events occurred in no patient, but TIMI bleeding events in 81 （47.09%） with major bleedings in three patients. All patients with major bleedings were classified as LTPR. Ticagrelor related dyspnea occurred in 31 （18.02%） patients, with 30 （21.28%） classified as LTPR and no one as HTPR （P = 0.02）. Conclusions In ticagrelor treated ACS patients, MAADP measured by TEG might be valuable for the prediction of major bleeding and ticagrelor related dyspnea. Due to the small number of patients with HTPR after ticagrelor maintenance treatment, larger scale study should be warranted to verify the relationship between MAADP defined HTPR and ticagrelor related ischemic events.展开更多
Clopidogrel is a mainstay in the treatment of patients with acute coronary syndromes or those receiving endovascular prostheses.However,its efficacy has been challenged in the recent past by studies suggesting variabl...Clopidogrel is a mainstay in the treatment of patients with acute coronary syndromes or those receiving endovascular prostheses.However,its efficacy has been challenged in the recent past by studies suggesting variable individual responsiveness and by new,more potent competitors,such as prasugrel and ticagrelor. But what is the actual body of evidence in support of clopidogrel?Is there any dark side of the moon?What is the role of prasugrel,which has already been approved in Europe and in the United States?And what will be the future role of ticagrelor,when approved for routine clinical practice?We hereby concisely summarize the scope of this clinical choice,providing arguments in favor and against each of the three antiplatelet agents:clopidogrel,prasugrel,and ticagrelor.展开更多
Objective:There exist conflicting data on the efficacy and safety of ticagrelor and clopidogrel in East Asian patients with acute coronary syndrome(ACS).We performed a meta-analysis to evaluate whether ticagrelor or c...Objective:There exist conflicting data on the efficacy and safety of ticagrelor and clopidogrel in East Asian patients with acute coronary syndrome(ACS).We performed a meta-analysis to evaluate whether ticagrelor or clopidogrel produces better outcomes for East Asian patients with ACS.Methods:We searched for randomized controlled trials reporting associations between ticagrelor and clopidogrel in East Asian patients with acute coronary syndrome in PubMed,EMBASE,web of science and Cochrane central register of controlled trials.Results:Ten studies involving 3715 participants were qualified for our analysis.The major adverse cardiovascular events(MACE)were significantly decreased in patients with ticagrelor treatment compared to those with clopidogrel(risk ratio[RR]:0.61;95%confidence interval[CI]:0.38-0.98;P=0.042).There was no significant difference in all-cause death(RR:0.89;95%CI:0.61-1.29;P=0.540),cardiovascular death(RR:0.86;95%CI:0.58-1.27;P=0.451),myocardial infarction(RR:0.91;95%CI:0.65-1.27;P=0.575)and stroke(RR:0.77;95%CI:0.44-1.36;P=0.372)between ticagrelor and clopidogrel.Ticagrelor was associated with a significantly higher risk of bleeding compared to clopidogrel(RR:1.71;95%CI:1.37-2.13;P=0.000).Conclusion:The present meta-analysis demonstrates that ticagrelor reduced the incidence of MACE in ACS patients from East Asia compared with clopidogrel.However,it increased the risk of bleeding.展开更多
Objective.To compare clinical efficacy of ticagrelor and clopidogrel for treatment of coronary heart disease with myocardial ischemia to provide references for later phase of clinical treatment.Methods.Ninety-six coro...Objective.To compare clinical efficacy of ticagrelor and clopidogrel for treatment of coronary heart disease with myocardial ischemia to provide references for later phase of clinical treatment.Methods.Ninety-six coronary heart disease patients with myocardial ischemia admitted to our hospital from July 20 to July 2019 were recruited as subjects.They were randomly divided into study group and control group according to parity of case number,with 48 patients in each group.Control group was given treatment with clopidogrel,while patients in study group were given treatment with ticagrelor.Clinical efficacy was compared between the both groups.Results.Comparison showed that total effective rate of clinical treatment was higher in study group when compared to control group(P<0.05).Frequency of ST segment depression,duration of ST segment depression,systolic blood pressure,diastolic blood pressure,heart rate and other clinical indicators in study group were superior to control group(P<0.05).Whole blood viscosity at low shear rate,whole blood viscosity at high shear rate,plasma viscosity shear rate,total cholesterol,triglyceride and other haemorheological parameters in study group were superior to control group(P<0.05).Conclusion.Application of ticagrelor has higher clinical efficacy than clopidogreal for coronary heart disease patients with myocardial ischemia.Clinical indicators and haemorheological parameters of myocardial ischemia patients were significantly improved.It should be promoted for application.展开更多
Objective:To explore the effect of ticagrelor sequential therapy after PCI on platelet function and cytokine secretion in patients with ACS.Methods: 176 patients with ACS who underwent PCI in our hospital between Janu...Objective:To explore the effect of ticagrelor sequential therapy after PCI on platelet function and cytokine secretion in patients with ACS.Methods: 176 patients with ACS who underwent PCI in our hospital between January 2015 and January 2018 were divided into the control group (n=92) who received conventional therapy and the ticagrelor group (n=84) who received ticagrelor sequential therapy based on the different therapies after PCI. The differences in serum platelet activation function indexes, myocardial injury indexes and chemokines were compared between the two groups of patients immediately after admission and 1 week after PCI.Results: Immediately after admission, serum platelet activation function indexes, myocardial injury indexes and chemokines were not significantly different between the two groups;1 week after PCI, serum platelet activation function indexes CD62p and CD63 levels of ticagrelor group were lower than those of control group;serum myocardial injury indexes hs-cTnⅠ, IMA, H-FABP and CK-MB contents were lower than those of control group;serum chemokines CXCL16, RANTES and MCP-1 contents were lower than those of control group.Conclusion: ticagrelor sequential therapy after PCI can effectively inhibit the excessive activation of platelets, reduce the postoperative myocardial injury and suppress the systemic inflammatory response in patients with ACS.展开更多
Objective: To compare the effect of ticagrelor and clopidogrel on serum inflammatory factor level in antiplatelet therapy for acute myocardial infarction (AMI) patients after percutaneous coronary intervention (PCI). ...Objective: To compare the effect of ticagrelor and clopidogrel on serum inflammatory factor level in antiplatelet therapy for acute myocardial infarction (AMI) patients after percutaneous coronary intervention (PCI). Methods: 113 cases of AMI underwent PCI in our hospital from March 2016 to February 2018 were selected and divided into two groups. The experimental group (n=58) received the ticagrelor, while the control group (n=55) received the clopidogrel. Then the platelet aggregation, serum inflammatory factors, liver and kidney function, and cardiovascular and cerebrovascular events at the post 6-mon follow-up were compared between groups. Results: The platelet aggregation rate had no difference between the two groups before PCI (P>0.05), which were higher in the control group than in the experimental group at the post-PCI 24 h and 7 d (P<0.05). The levels of C-reactive protein (CRP), interleukin-6 (IL-6), and interleukin-8 (IL-8) had no difference between the two groups before PCI (P>0.05), which were higher in the control group than in the experimental group at the post-PCI 24 h and 7 d (P<0.05). The preoperative glutamic pyruvic transaminase (ALT) had no difference with that at the post-PCI 24 h and 7 d in both groups (P>0.05). The serum creatinine (Scr) levels had no difference between the two groups before PCI (P>0.05), which were lower in the control group than in the experimental group at the post-PCI 24 h and 7 d (P<0.05). The incidence rate of the cardiovascular and cerebrovascular events at the post 6-months follow-up of the control group was higher than that of the experimental group (14.55% (8/55) vs 5.17% (3/58), P<0.05)Conclusion: Compared with the clopidogrel treatment, the application of ticagrelor has a better effect in antiplatelet therapy for AMI patients underwent PCI, which can effectively control serum inflammatory factor levels, stabilize liver function, reduce the occurrence of cardiovascular and cerebrovascular events, and improve the prognosis.展开更多
Objective:To investigate the effects of different doses of ticagrelor on coronary blood flow, inflammatory response and myocardial enzyme spectrum in patients with acute myocardial infarction.Methods: A total of 180 p...Objective:To investigate the effects of different doses of ticagrelor on coronary blood flow, inflammatory response and myocardial enzyme spectrum in patients with acute myocardial infarction.Methods: A total of 180 patients with acute myocardial infarction who were treated in our hospital between December 2015 and March 2017 were reviewed and divided into the routine dose group (n=87) who accepted routine dose of ticagrelor therapy and loading dose group (n=93) who accepted loading dose of ticagrelor therapy. The differences in coronary blood flow, inflammatory response and myocardial enzyme spectrum were compared between the two groups before and after treatment.Results: Immediately after admission, there was no statistically significant difference in the coronary blood flow levels, inflammatory response and myocardial enzyme spectrum contents between the two groups. At 24 h after percutaneous coronary intervention (PCI), the coronary blood flow parameters SPV, DPV and CFVR levels in loading dose group were higher than those in routine dose group;serum inflammatory factors PCT, IL-6 and CRP contents were lower than those of routine dosage group;myocardial enzyme spectrum indexes cTnⅠ, LDH, HBDH and MB contents were lower than those of routine dose group.Conclusion: Loading dose of ticagrelor therapy before PCI can effectively optimize the coronary blood flow after PCI, reduce the systemic inflammatory response and protect the myocardial function in patients with acute myocardial infarction.展开更多
Objective: To explore the effects of Ticagrelor on oxidative stress, coagulation function, platelet function and related factors in patients with coronary artery disease undergoing interventional therapy. Methods: A t...Objective: To explore the effects of Ticagrelor on oxidative stress, coagulation function, platelet function and related factors in patients with coronary artery disease undergoing interventional therapy. Methods: A total of 140 patients with coronary artery disease who underwent percutaneous coronary intervention in our hospital from October 2016 to March 2018 were selected as the study subjects and were divided into control group (70 cases) and observation group (70 cases) by drawing lots. Both groups were treated with symptomatic routine therapy before operation. On this basis, the control group was treated with clopidogrel before operation, and the observation group was treated with Ticagrelor before operation on the basis of routine treatment. The changes of oxidative stress, coagulation index, platelet function and related factors were compared between the two groups before and after treatment. Results: Before treatment, there were no significant differences in oxidative stress factors, coagulation parameters, platelet parameters and related factors factors between the two groups. After treatment, the levels of MDA, MPAR, VEGF and MMP-9 in the two groups were lower than those before treatment, while the levels of SOD, APTT, TT and PT were higher than those before treatment;and the levels of MDA, MPAR, VEGF, MMP-9, APTT and PT in the observation group were significantly lower than those in the control group after treatment, while the levels fo SOD, TT and IPA in the observation group were significantly higher than those in the control group. Conclusions: Ticagrelor can better reduce oxidative stress injury, improve coagulation function and coronary stenosis, and inhibit platelet aggregation in patients with coronary heart disease undergoing PCI than clopidogrel. It has clinical popularization significance.展开更多
Objective: To explore the influence of ticagrelor on platelet function, plaque properties and inflammatory response in patients with acute coronary syndrome (ACS) complicated by clopidogrel resistance. Methods: A tota...Objective: To explore the influence of ticagrelor on platelet function, plaque properties and inflammatory response in patients with acute coronary syndrome (ACS) complicated by clopidogrel resistance. Methods: A total of 58 patients with acute coronary syndrome complicated by clopidogrel resistance who were treated in Xiangyang No.1 People's Hospital between August 2015 and April 2017 were divided into control group (n=29) and ticagrelor group (n=29) by random number table method. Control group were treated with aspirin combined with doubling dosage of clopidogrel, and ticagrelor group were treated with aspirin combined with ticagrelor. The differences in platelet function, plaque properties, inflammatory response, and so on were compared between the two groups before and after treatment. Results: There were no significant differences in platelet function, plaque properties and inflammatory response between the two groups before treatment. After 7 d and 14 d of treatment, platelet function indexes MPAR and PRI levels in ticagrelor group were lower than those in control group;serum plaque property-related indexes Hcy, sCD40 and sCD40L contents were lower than those in control group;serum inflammatory factors CRP and MPO contents were lower than those in control group whereas APN contents were higher than those in control group. Conclusion: Ticagrelor therapy can effectively inhibit the platelet activity, stabilize the plaques and reduce the systemic inflammatory response in patients with acute coronary syndrome complicated by clopidogrel resistance.展开更多
Objective:To study the influence and molecular mechanism of ticagrelor on cerebral ischemia reperfusion injury in rats.Methods:SD rats were selected as experimental animals and divided into control group, model group,...Objective:To study the influence and molecular mechanism of ticagrelor on cerebral ischemia reperfusion injury in rats.Methods:SD rats were selected as experimental animals and divided into control group, model group, ticagrelor group and clopidogrel group, cerebral ischemic reperfusion injury models were made, then ticagrelor group were given intragastric administration of 150 mg ticagrelor, clopidogrel group were given intragastric administration of 90 mg clopidogrel. 1 week after intervention, the brain water content as well as the contents of oxidative stress molecules and inflammatory factors were measured.Results: Water content in brain, MDA, Ox-LDL, NF-kB, TNF-α, IL-1β and IL-6 contents in brain tissue as well as TNF-α, IL-1β and IL-6 contents in serum of model group were significantly higher than those of control group while SOD, GSH-Px and Prdx6 contents in brain tissue were significantly lower than those of control group;water content in brain, MDA, Ox-LDL, NF-kB, TNF-α, IL-1β and IL-6 contents in brain tissue as well as TNF-α, IL-1β and IL-6 contents in serum of ticagrelor group and clopidogrel group were significantly lower than those of model group while SOD, GSH-Px and Prdx6 contents in brain tissue were significantly higher than those of model group;water content in brain, MDA, Ox-LDL, NF-kB, TNF-α, IL-1β and IL-6 contents in brain tissue as well as TNF-α, IL-1β and IL-6 contents in serum of ticagrelor group were significantly lower than those of clopidogrel group while SOD, GSH-Px and Prdx6 contents in brain tissue were significantly higher than those of clopidogrel group. Conclusion:Ticagrelor can be more effective in inhibiting oxidative stress response and inflammatory response, and reducing the cerebral ischemia reperfusion injury than clopidogrel.展开更多
Objective:To investigate the effect of ticagrelor assisted PCI in treatment the elderly patients with acute ST elevation myocardial infarction (STEMI) on oxidative stress and inflammatory factor level.Methods:A total ...Objective:To investigate the effect of ticagrelor assisted PCI in treatment the elderly patients with acute ST elevation myocardial infarction (STEMI) on oxidative stress and inflammatory factor level.Methods:A total of 100 cases elderly patients with STEMI were selected that they were being treated with PCI. According to the digital list method was divided into the study group and control group, and 50 cases in each group. The control group was treated with PCI and the strong heart, anticoagulation, vasodilation, prevention of infection and other comprehensive treatment of myocardial infarction, the study group were given ticagrelor treatment which was based on the comprehensive treatment of myocardial infarction. The level change were compared that oxidative stress index (MDA), glutathione peroxidase (GSH-Px), superoxide dismutase (SOD) activity and inflammatory factor hypersensitive C reactive protein (hs-CRP), N-terminal pro brain natriuretic peptide (NT-proBNP) and interleukin -6 (IL-6) between the two groups in before treatment (T0), treatment with 7 d (T1), 14 d (T2), 30 d (T3).Results:(1)There was no significant difference in serum MDA, GSH-Px and SOD levels between the two groups in the T0. Two groups serum MDA level were higher than theT0, and the GSH-Px and SOD levels were lower than the T0 after operation in the T1.And the serum MDA level were lower than T0, T1, GSH-Px and SOD levels were higher than T0, T1in the T2, T3.The T3 serum MDA level was lower than T2, GSH-Px and SOD levels were higher than T2.Even the serum MDA was significantly lower than the control group T1, T2, T3 and the GSH-Px and SOD were higher than those of the control group T1, T2, T3 at the study groupT1, T2, T3, the difference was statistically significant. (2)There was no significant difference in T0 of the serum hs-CRP, IL-6 and NT-proBNP levels between the two groups. Two groups serum hs-CRP, IL-6 and NT-proBNP level were higher than the T0 after operation in the T1.And the serum hs-CRP, IL-6 and NT-proBNP levels were higher than T0, T1in the T2, T3.The T3 serum hs-CRP, IL-6 and NT-proBNP levels were lower than T2.and that the serum hs-CRP, IL-6 and NT-proBNP levels were significantly lower than the control group T1, T2, T3 at the study groupT1, T2, T3, so the difference was statistically significant.Conclusion:The treatment method will be able to reduce oxidative stress injury and effectively control the inflammatory response that ticagrelor assisted PCI in treatment the elderly patients with acute ST elevation myocardial infarction (STEMI).展开更多
文摘Background There is great debate on the possible adverse interaction between proton pump inhibitors （PPIs） and clopidogrel. In ad- dition, whether the use of PPIs affects the clinical efficacy of ticagrelor remains less known. We aimed to determine the impact of concomi- tant administration of PPIs and clopidogrel or ticagrelor on clinical outcomes in patients with acute coronary syndrome （ACS） after percuta- neous coronary intervention （PCI）. Methods We retrospectively analyzed data fi＇om a ＂real world＂, international, multi-center registry between 2003 and 2014 （n = 15,401） and assessed the impact of concomitant administration of PPIs and clopidogrel or ticagrelor on 1-year composite primary endpoint （all-cause death, re-infarction, or severe bleeding） in patients with ACS after PCI. Results Of 9429 patients in the final cohort, 54.8% （n = 5165） was prescribed a PPI at discharge. Patients receiving a PPI were older, more often female, and were more likely to have comorbidities. No association was observed between PPI use and the primary endpoint for patients receiving clopidogrel （ad- justed HR： 1.036; 95% CI： 0.903-1.189） or ticagrelor （adjusted HR： 2.320; 95% CI： 0.875-45.151） （Pinteraction = 0.2004）. Similarly, use of a PPI was not associated with increased risk of all-cause death, re-infarction, or a decreased risk of severe bleeding for patients treated with either clopidogrel or ticagrelor. Conclusions In patients with ACS following PCI, concomitant use of PPIs was not associated with in- creased risk of adverse outcomes in patients receiving either clopidogrel or ticagrelor. Our findings indicate it is reasonable to use a PPI in combination with clopidogrel or ticagrelor, especially in patients with a higher risk of gastrointestinal bleeding.
基金supported by the grants from the National Natural Science Foundation of China(No.81470387)Hubei Province’s Outstanding Medical Academic Leader Program,China
文摘We performed a meta-analysis of randomized controlled trials（RCTs） to investigate the efficacy and safety of ticagrelor（TIC） vs. clopidogrel（CLO） in patients undergoing percutaneous coronary intervention（PCI）. In Jun 2016, a literature search was started and all the studies were conducted from 2010 to 2015. We systematically searched the literature through the MEDLINE database, Cochrane library, and EMBASE database. Quality assessments were evaluated with Jadad quality scale. Data were extracted considering the characteristics of efficacy and safety designs. Six RCTs enrolling 26 244 participants and satisfying the inclusion criteria were finally analyzed. There was a significant decrease of all-cause mortality（MD=0.83, 95%CI=0.74–0.93, P=0.001） and myocardial infarction（MI）（MD=0.78, 95%CI=0.70–0.88, P=0.000）. There were no significant differences in stroke（MD=1.34, 95%CI=0.99–1.79, P=0.06）, total bleeding（MD=0.97, 95%CI=0.84–1.12, P=0.66）, minor or major bleeding（MD=1.06, 95%CI=0.94–1.19, P=0.35） in patients undergoing PCI after treatment with TIC vs. CLO. TIC could be more significant in decreasing all-cause mortality and MI than CLO, but there were no significant differences between TIC and CLO in inhibiting stroke, major bleeding, major or minor bleeding in patients undergoing PCI.
文摘Ticagrelor is a potent,direct P2Y12 antagonist with rapid onset of action and intense platelet inhibition,indicated in patients with acute coronary syndromes(ACS).This drug is usually well tolerated,but some patients experience serious adverse effects:Major bleeding;gastrointestinal disturbances;dyspnoea;ventricular pauses > 3 s.Given the unexpected high incidence of bradyarrhythmias,a PLATO substudy monitored this side effect,showing that ticagrelor was associated with an increase in the rate of sinus bradycardia and sinus arrest compared to clopidogrel.This side effect was usually transient,asymptomatic and not associated with higher incidence of severe atrioventricular(AV) block or pacemaker needs.A panel of experts from Food and Drug Administration did not consider bradyarrhythmias a serious problem in clinical practice and,accordingly,current labeling of the drug does not give any precaution or contraindication regarding this issue.However,recently some articles have described ACS patients with high-degree,life-threatening,AV block requiring drug discontinuation and,in some cases,pacemaker implantation.In this paper,we describe and discuss five published case reports of severe AV block following ticagrelor therapy and two other cases managed in our Hospital.The analysis of literature suggests that,although rarely,ticagrelor can be associated with lifethreatening AV block.Caution and careful monitoring are required especially in patients with already compromised conduction system and/or treated with AV blocking agents.Future studies,with long-term rhythm monitoring,would help to define the outcome of patients at higher risk of developing this complication.
基金This work was supported by grants from the Beijing Natural Science Foundation of China （No. 7152129） and National Natural Science Foundation of China （No. 30971259）, the Clinical Research Supportive Fund General Hospital of Chinese People＇s Liberation Army （No. 2012FC-TSYS-3042）. There are no potential conflicts of interest to declare.
文摘Background Ticagrelor provides enhanced antiplatelet efficacy but increased risk of bleeding and dyspnea. This study aimed to display the relationship between ADP-induced platelet-fibrin clot strength （MAADP） and clinical outcomes in acute coronary syndrome （ACS） patients treated by ticagrelor. Methods Consecutive Chinese-Han patients with ACS who received maintenance dose ofticagrelor on top of aspirin were recruited. After 5-day ticagrelor maintenance treatment, MAADP measured by thrombelastography （TEG） were recorded for the evaluation of ticagrelor anti-platelet reactivity. Pre-specified cutoffs of MAADP 〉 47 mm for high on-treatment platelet reactivity （HTPR） and MAADP 〈 31 mm for low on-treatment platelet reactivity （LTPR） were applied for evaluation. The occurrences of primary ischemic cardiovascular events （including a composite of cardiac death, non-fatal myocardial infarction and stroke）, the Thrombolysis in Myocardial Infarction （TIMI） defined bleeding events, and ticagrelor related dyspnea were recorded after a follow-up of three months. Results Overall, 176 ACS patients （Male： 79.55%, Age： 59.91 ±10.54 years） under ticagrelor maintenance treatment were recruited. The value of MAADP ranged from 4.80% to 72.90% （21.27% ± 12.07% on average）, with the distribution higher skewed towards the lower values. Using the pre-specific cutoffs for HTPR and LTPR, seven patients （3.98%） were identified as HTPR and 144 patients （81.82%） as LTPR. After a follow-up of three months in 172 patients, major cardiovascular events occurred in no patient, but TIMI bleeding events in 81 （47.09%） with major bleedings in three patients. All patients with major bleedings were classified as LTPR. Ticagrelor related dyspnea occurred in 31 （18.02%） patients, with 30 （21.28%） classified as LTPR and no one as HTPR （P = 0.02）. Conclusions In ticagrelor treated ACS patients, MAADP measured by TEG might be valuable for the prediction of major bleeding and ticagrelor related dyspnea. Due to the small number of patients with HTPR after ticagrelor maintenance treatment, larger scale study should be warranted to verify the relationship between MAADP defined HTPR and ticagrelor related ischemic events.
文摘Clopidogrel is a mainstay in the treatment of patients with acute coronary syndromes or those receiving endovascular prostheses.However,its efficacy has been challenged in the recent past by studies suggesting variable individual responsiveness and by new,more potent competitors,such as prasugrel and ticagrelor. But what is the actual body of evidence in support of clopidogrel?Is there any dark side of the moon?What is the role of prasugrel,which has already been approved in Europe and in the United States?And what will be the future role of ticagrelor,when approved for routine clinical practice?We hereby concisely summarize the scope of this clinical choice,providing arguments in favor and against each of the three antiplatelet agents:clopidogrel,prasugrel,and ticagrelor.
基金National Natural Science Foundation of China(81830012,81900302,82070336).
文摘Objective:There exist conflicting data on the efficacy and safety of ticagrelor and clopidogrel in East Asian patients with acute coronary syndrome(ACS).We performed a meta-analysis to evaluate whether ticagrelor or clopidogrel produces better outcomes for East Asian patients with ACS.Methods:We searched for randomized controlled trials reporting associations between ticagrelor and clopidogrel in East Asian patients with acute coronary syndrome in PubMed,EMBASE,web of science and Cochrane central register of controlled trials.Results:Ten studies involving 3715 participants were qualified for our analysis.The major adverse cardiovascular events(MACE)were significantly decreased in patients with ticagrelor treatment compared to those with clopidogrel(risk ratio[RR]:0.61;95%confidence interval[CI]:0.38-0.98;P=0.042).There was no significant difference in all-cause death(RR:0.89;95%CI:0.61-1.29;P=0.540),cardiovascular death(RR:0.86;95%CI:0.58-1.27;P=0.451),myocardial infarction(RR:0.91;95%CI:0.65-1.27;P=0.575)and stroke(RR:0.77;95%CI:0.44-1.36;P=0.372)between ticagrelor and clopidogrel.Ticagrelor was associated with a significantly higher risk of bleeding compared to clopidogrel(RR:1.71;95%CI:1.37-2.13;P=0.000).Conclusion:The present meta-analysis demonstrates that ticagrelor reduced the incidence of MACE in ACS patients from East Asia compared with clopidogrel.However,it increased the risk of bleeding.
文摘Objective.To compare clinical efficacy of ticagrelor and clopidogrel for treatment of coronary heart disease with myocardial ischemia to provide references for later phase of clinical treatment.Methods.Ninety-six coronary heart disease patients with myocardial ischemia admitted to our hospital from July 20 to July 2019 were recruited as subjects.They were randomly divided into study group and control group according to parity of case number,with 48 patients in each group.Control group was given treatment with clopidogrel,while patients in study group were given treatment with ticagrelor.Clinical efficacy was compared between the both groups.Results.Comparison showed that total effective rate of clinical treatment was higher in study group when compared to control group(P<0.05).Frequency of ST segment depression,duration of ST segment depression,systolic blood pressure,diastolic blood pressure,heart rate and other clinical indicators in study group were superior to control group(P<0.05).Whole blood viscosity at low shear rate,whole blood viscosity at high shear rate,plasma viscosity shear rate,total cholesterol,triglyceride and other haemorheological parameters in study group were superior to control group(P<0.05).Conclusion.Application of ticagrelor has higher clinical efficacy than clopidogreal for coronary heart disease patients with myocardial ischemia.Clinical indicators and haemorheological parameters of myocardial ischemia patients were significantly improved.It should be promoted for application.
基金Natural Science Foundation of Qinghai Province.Project No:Y2008c34.
文摘Objective:To explore the effect of ticagrelor sequential therapy after PCI on platelet function and cytokine secretion in patients with ACS.Methods: 176 patients with ACS who underwent PCI in our hospital between January 2015 and January 2018 were divided into the control group (n=92) who received conventional therapy and the ticagrelor group (n=84) who received ticagrelor sequential therapy based on the different therapies after PCI. The differences in serum platelet activation function indexes, myocardial injury indexes and chemokines were compared between the two groups of patients immediately after admission and 1 week after PCI.Results: Immediately after admission, serum platelet activation function indexes, myocardial injury indexes and chemokines were not significantly different between the two groups;1 week after PCI, serum platelet activation function indexes CD62p and CD63 levels of ticagrelor group were lower than those of control group;serum myocardial injury indexes hs-cTnⅠ, IMA, H-FABP and CK-MB contents were lower than those of control group;serum chemokines CXCL16, RANTES and MCP-1 contents were lower than those of control group.Conclusion: ticagrelor sequential therapy after PCI can effectively inhibit the excessive activation of platelets, reduce the postoperative myocardial injury and suppress the systemic inflammatory response in patients with ACS.
文摘Objective: To compare the effect of ticagrelor and clopidogrel on serum inflammatory factor level in antiplatelet therapy for acute myocardial infarction (AMI) patients after percutaneous coronary intervention (PCI). Methods: 113 cases of AMI underwent PCI in our hospital from March 2016 to February 2018 were selected and divided into two groups. The experimental group (n=58) received the ticagrelor, while the control group (n=55) received the clopidogrel. Then the platelet aggregation, serum inflammatory factors, liver and kidney function, and cardiovascular and cerebrovascular events at the post 6-mon follow-up were compared between groups. Results: The platelet aggregation rate had no difference between the two groups before PCI (P>0.05), which were higher in the control group than in the experimental group at the post-PCI 24 h and 7 d (P<0.05). The levels of C-reactive protein (CRP), interleukin-6 (IL-6), and interleukin-8 (IL-8) had no difference between the two groups before PCI (P>0.05), which were higher in the control group than in the experimental group at the post-PCI 24 h and 7 d (P<0.05). The preoperative glutamic pyruvic transaminase (ALT) had no difference with that at the post-PCI 24 h and 7 d in both groups (P>0.05). The serum creatinine (Scr) levels had no difference between the two groups before PCI (P>0.05), which were lower in the control group than in the experimental group at the post-PCI 24 h and 7 d (P<0.05). The incidence rate of the cardiovascular and cerebrovascular events at the post 6-months follow-up of the control group was higher than that of the experimental group (14.55% (8/55) vs 5.17% (3/58), P<0.05)Conclusion: Compared with the clopidogrel treatment, the application of ticagrelor has a better effect in antiplatelet therapy for AMI patients underwent PCI, which can effectively control serum inflammatory factor levels, stabilize liver function, reduce the occurrence of cardiovascular and cerebrovascular events, and improve the prognosis.
文摘Objective:To investigate the effects of different doses of ticagrelor on coronary blood flow, inflammatory response and myocardial enzyme spectrum in patients with acute myocardial infarction.Methods: A total of 180 patients with acute myocardial infarction who were treated in our hospital between December 2015 and March 2017 were reviewed and divided into the routine dose group (n=87) who accepted routine dose of ticagrelor therapy and loading dose group (n=93) who accepted loading dose of ticagrelor therapy. The differences in coronary blood flow, inflammatory response and myocardial enzyme spectrum were compared between the two groups before and after treatment.Results: Immediately after admission, there was no statistically significant difference in the coronary blood flow levels, inflammatory response and myocardial enzyme spectrum contents between the two groups. At 24 h after percutaneous coronary intervention (PCI), the coronary blood flow parameters SPV, DPV and CFVR levels in loading dose group were higher than those in routine dose group;serum inflammatory factors PCT, IL-6 and CRP contents were lower than those of routine dosage group;myocardial enzyme spectrum indexes cTnⅠ, LDH, HBDH and MB contents were lower than those of routine dose group.Conclusion: Loading dose of ticagrelor therapy before PCI can effectively optimize the coronary blood flow after PCI, reduce the systemic inflammatory response and protect the myocardial function in patients with acute myocardial infarction.
文摘Objective: To explore the effects of Ticagrelor on oxidative stress, coagulation function, platelet function and related factors in patients with coronary artery disease undergoing interventional therapy. Methods: A total of 140 patients with coronary artery disease who underwent percutaneous coronary intervention in our hospital from October 2016 to March 2018 were selected as the study subjects and were divided into control group (70 cases) and observation group (70 cases) by drawing lots. Both groups were treated with symptomatic routine therapy before operation. On this basis, the control group was treated with clopidogrel before operation, and the observation group was treated with Ticagrelor before operation on the basis of routine treatment. The changes of oxidative stress, coagulation index, platelet function and related factors were compared between the two groups before and after treatment. Results: Before treatment, there were no significant differences in oxidative stress factors, coagulation parameters, platelet parameters and related factors factors between the two groups. After treatment, the levels of MDA, MPAR, VEGF and MMP-9 in the two groups were lower than those before treatment, while the levels of SOD, APTT, TT and PT were higher than those before treatment;and the levels of MDA, MPAR, VEGF, MMP-9, APTT and PT in the observation group were significantly lower than those in the control group after treatment, while the levels fo SOD, TT and IPA in the observation group were significantly higher than those in the control group. Conclusions: Ticagrelor can better reduce oxidative stress injury, improve coagulation function and coronary stenosis, and inhibit platelet aggregation in patients with coronary heart disease undergoing PCI than clopidogrel. It has clinical popularization significance.
文摘Objective: To explore the influence of ticagrelor on platelet function, plaque properties and inflammatory response in patients with acute coronary syndrome (ACS) complicated by clopidogrel resistance. Methods: A total of 58 patients with acute coronary syndrome complicated by clopidogrel resistance who were treated in Xiangyang No.1 People's Hospital between August 2015 and April 2017 were divided into control group (n=29) and ticagrelor group (n=29) by random number table method. Control group were treated with aspirin combined with doubling dosage of clopidogrel, and ticagrelor group were treated with aspirin combined with ticagrelor. The differences in platelet function, plaque properties, inflammatory response, and so on were compared between the two groups before and after treatment. Results: There were no significant differences in platelet function, plaque properties and inflammatory response between the two groups before treatment. After 7 d and 14 d of treatment, platelet function indexes MPAR and PRI levels in ticagrelor group were lower than those in control group;serum plaque property-related indexes Hcy, sCD40 and sCD40L contents were lower than those in control group;serum inflammatory factors CRP and MPO contents were lower than those in control group whereas APN contents were higher than those in control group. Conclusion: Ticagrelor therapy can effectively inhibit the platelet activity, stabilize the plaques and reduce the systemic inflammatory response in patients with acute coronary syndrome complicated by clopidogrel resistance.
文摘Objective:To study the influence and molecular mechanism of ticagrelor on cerebral ischemia reperfusion injury in rats.Methods:SD rats were selected as experimental animals and divided into control group, model group, ticagrelor group and clopidogrel group, cerebral ischemic reperfusion injury models were made, then ticagrelor group were given intragastric administration of 150 mg ticagrelor, clopidogrel group were given intragastric administration of 90 mg clopidogrel. 1 week after intervention, the brain water content as well as the contents of oxidative stress molecules and inflammatory factors were measured.Results: Water content in brain, MDA, Ox-LDL, NF-kB, TNF-α, IL-1β and IL-6 contents in brain tissue as well as TNF-α, IL-1β and IL-6 contents in serum of model group were significantly higher than those of control group while SOD, GSH-Px and Prdx6 contents in brain tissue were significantly lower than those of control group;water content in brain, MDA, Ox-LDL, NF-kB, TNF-α, IL-1β and IL-6 contents in brain tissue as well as TNF-α, IL-1β and IL-6 contents in serum of ticagrelor group and clopidogrel group were significantly lower than those of model group while SOD, GSH-Px and Prdx6 contents in brain tissue were significantly higher than those of model group;water content in brain, MDA, Ox-LDL, NF-kB, TNF-α, IL-1β and IL-6 contents in brain tissue as well as TNF-α, IL-1β and IL-6 contents in serum of ticagrelor group were significantly lower than those of clopidogrel group while SOD, GSH-Px and Prdx6 contents in brain tissue were significantly higher than those of clopidogrel group. Conclusion:Ticagrelor can be more effective in inhibiting oxidative stress response and inflammatory response, and reducing the cerebral ischemia reperfusion injury than clopidogrel.
文摘Objective:To investigate the effect of ticagrelor assisted PCI in treatment the elderly patients with acute ST elevation myocardial infarction (STEMI) on oxidative stress and inflammatory factor level.Methods:A total of 100 cases elderly patients with STEMI were selected that they were being treated with PCI. According to the digital list method was divided into the study group and control group, and 50 cases in each group. The control group was treated with PCI and the strong heart, anticoagulation, vasodilation, prevention of infection and other comprehensive treatment of myocardial infarction, the study group were given ticagrelor treatment which was based on the comprehensive treatment of myocardial infarction. The level change were compared that oxidative stress index (MDA), glutathione peroxidase (GSH-Px), superoxide dismutase (SOD) activity and inflammatory factor hypersensitive C reactive protein (hs-CRP), N-terminal pro brain natriuretic peptide (NT-proBNP) and interleukin -6 (IL-6) between the two groups in before treatment (T0), treatment with 7 d (T1), 14 d (T2), 30 d (T3).Results:(1)There was no significant difference in serum MDA, GSH-Px and SOD levels between the two groups in the T0. Two groups serum MDA level were higher than theT0, and the GSH-Px and SOD levels were lower than the T0 after operation in the T1.And the serum MDA level were lower than T0, T1, GSH-Px and SOD levels were higher than T0, T1in the T2, T3.The T3 serum MDA level was lower than T2, GSH-Px and SOD levels were higher than T2.Even the serum MDA was significantly lower than the control group T1, T2, T3 and the GSH-Px and SOD were higher than those of the control group T1, T2, T3 at the study groupT1, T2, T3, the difference was statistically significant. (2)There was no significant difference in T0 of the serum hs-CRP, IL-6 and NT-proBNP levels between the two groups. Two groups serum hs-CRP, IL-6 and NT-proBNP level were higher than the T0 after operation in the T1.And the serum hs-CRP, IL-6 and NT-proBNP levels were higher than T0, T1in the T2, T3.The T3 serum hs-CRP, IL-6 and NT-proBNP levels were lower than T2.and that the serum hs-CRP, IL-6 and NT-proBNP levels were significantly lower than the control group T1, T2, T3 at the study groupT1, T2, T3, so the difference was statistically significant.Conclusion:The treatment method will be able to reduce oxidative stress injury and effectively control the inflammatory response that ticagrelor assisted PCI in treatment the elderly patients with acute ST elevation myocardial infarction (STEMI).
