Administration of Ticagrelor and Double-Dose Clopidogrel Based on Platelet Reactivity Determined by VerifyNow-P2Y12 for Chinese Subjects After Elective PCI

• Published in: International Heart Journal Vol. 58; no. 2; pp. 167 - 173
• Main Authors: Zhao, Xue-Yan, Liu, Gang, Cui, Jin-Gang, Zheng, Xin-Xin, Wu, Xi, Lu, Jie, Huang, Xiao-Hong
• Format: Journal Article
• Language: English
• Published: Japan International Heart Journal Association 2017; Japan Science and Technology Agency
• Subjects: Adenosine - administration & dosage; Adenosine - analogs & derivatives; Aged; Cardiovascular disease; Circulatory system; Clopidogrel; Coronary artery disease; CYP2C19; Cytochrome P-450 CYP2C19 - genetics; Female; Genetic diversity; Heart diseases; High platelet reactivity; Humans; Ischemia; Male; Middle Aged; Patients; Percutaneous Coronary Intervention - adverse effects; Platelet Activation - genetics; Platelets; Postoperative Complications - prevention & control; Purinergic P2Y Receptor Antagonists - administration & dosage; Statins; Thrombosis - etiology; Thrombosis - prevention & control; Ticlopidine - administration & dosage; Ticlopidine - analogs & derivatives
• ISSN: 1349-2365; 1349-3299
• DOI: 10.1536/ihj.16-222

Previous studies have identified high on treatment platelet reactivity (HTPR) as a potent factor predicting ischemic events for patients with coronary heart disease. We assessed the efficacy and safety of ticagrelor (90 mg twice-daily) and double-dose of clopidogrel (150 mg once-daily) among Chinese patients for elective percutaneous coronary intervention. We enrolled 40 patients with HTPR from among 317 patients with non-ST-segment elevation acute coronary syndromes after a successful elective percutaneous coronary intervention (PCI). Platelet reactivity was measured by VerifyNow P2Y12 assay. Platelet reactivity was significantly lower for both groups when compared with baseline platelet reactivity after medication adjustment (all P < 0.001). The mean platelet reactivity units (PRU) was significantly lower for the ticagrelor group compared with that of the clopidogrel group over time (all P < 0.001). The differences in the rate of sustained HTPR at different time points between the two groups were significant (2 hours: 0% versus 60%; 8 hours: 5.6% versus 50%; 24 hours: 5.9% versus 43.8%, all P < 0.05). Genetic variation of CYP2C19*2 had no impact on PRU means or rate of HTPR in the ticagrelor group (P > 0.05). During the 30-day follow-up, no MACE occurred in any patient, and the overall risk of bleeding showed no difference between the two groups (35% versus 21%, P = 0.48). Our results suggest that ticagrelor may achieve a more rapid and greater platelet inhibition than double-dose clopidogrel. Further studies are still needed to assess the differences in efficacy and safety between ticagrelor and double-dose clopidogrel administration for Chinese patients post elective PCI.