Efficacy and safety of ticagrelor versus clopidogrel with different dosage in high-risk patients with acute coronary syndrome

Abstract Background Dual antiplatelet therapy is recommended as a standard antiplatelet strategy in acute coronary syndrome. For those with reduced pharmacologic response to clopidogrel, strengthening antiplatelet therapy ( clopidogrel150mg daily) may reduce adverse clinical events. Ticagreloris a direct-acting inhibitor of the adenosine diphosphatereceptor P2Y12that has a more rapid onset and offset than clopidogrel. Methods In this retrospective study, we compared ticagrelor(180mg loading dose90mg twice daily thereafter), clopidogrel(300mg loading dose, 75mg or 150mg daily thereafter) for the prevention of cardiovascular events in 273 high-risk patients admitted to coronary care unitwith acute coronary syndrome. Results The rate of IST in hospital was significantly reduced in patients of ticagrelorgroup comparing with those receiving clopidogrel75mg (0.69% vs 8.2%, p=0.009). Moreover, the TVR rate was less in the ticagrelorgroup than clopidogrel75mg group (2.7% vs 13.1%, p=0.007) 6months follow-up. The incidence of MACCE has no difference between the two clopidogrelgroups. Kaplan–Meier analysis of MACCE-free indicated that there was no difference between the three groups. Ticagrelorsignificantly increased the rate of minor bleeding compared with clopidogrel75mg daily during hospital (45.5% vs 26.2%,p=0.012) and 6-month follow-up (66.9% vs 45.9%,p=0.004).Bleeding-free prognosis was significantly better in the clopidogrel75mg daily group. Conclusions In patients with acute coronary syndromeundergoing PCI, the rate of in-stent thrombosis and TVR were significantly reduced treated with ticagrelorcompared with clopidogrel75mg daily, without an increase of overall major bleeding, but with an increase of minor bleeding.