title: 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 (clopidogrel 150mg daily) may reduce adverse clinical events. Ticagrelor is a direct-acting inhibitor of the adenosine diphosphate receptor P2Y12 that has a more rapid onset and offset than clopidogrel.
  
  
  METHODS
  In this retrospective study, we compared ticagrelor (180mg loading dose 90mg 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 unit with acute coronary syndrome.
  
  
  RESULTS
  The rate of IST in hospital was significantly reduced in patients of ticagrelor group comparing with those receiving clopidogrel 75mg (0.69% vs 8.2%, p=0.009). Moreover, the TVR rate was less in the ticagrelor group than clopidogrel 75mg group (2.7% vs 13.1%, p=0.007) 6months follow-up. The incidence of MACCE has no difference between the two clopidogrel groups. Kaplan-Meier analysis of MACCE-free indicated that there was no difference between the three groups. Ticagrelor significantly increased the rate of minor bleeding compared with clopidogrel 75mg 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 clopidogrel 75mg daily group.
  
  
  CONCLUSIONS
  In patients with acute coronary syndrome undergoing PCI, the rate of in-stent thrombosis and TVR were significantly reduced treated with ticagrelor compared with clopidogrel 75mg daily, without an increase of overall major bleeding, but with an increase of minor bleeding.
authors.affiliation: Department of Geriatric Cardiology, The First Affiliated Hospital, China Medical University, Shenyang, PR China; Department of Cardiology, The General Hospital of Tianjin Medical University, Tianjin, PR China.
authors.forename: Yan-Guo
authors.initials: YG
authors.lastname: Xin
authors.affiliation: Department of Cardiology, The First Affiliated Hospital, China Medical University, Shenyang, PR China.
authors.forename: Hai-Shan
authors.initials: HS
authors.lastname: Zhang
authors.affiliation: Department of Cardiology, The First Affiliated Hospital, China Medical University, Shenyang, PR China.
authors.forename: Yu-Ze
authors.initials: YZ
authors.lastname: Li
authors.affiliation: Department of Cardiology, The First Affiliated Hospital, China Medical University, Shenyang, PR China.
authors.forename: Qi-Gang
authors.initials: QG
authors.lastname: Guan
authors.affiliation: Department of Cardiology, The First Affiliated Hospital, China Medical University, Shenyang, PR China.
authors.forename: Liang
authors.initials: L
authors.lastname: Guo
authors.affiliation: Department of Cardiology, The First Affiliated Hospital, China Medical University, Shenyang, PR China.
authors.forename: Yuan
authors.initials: Y
authors.lastname: Gao
authors.affiliation: Department of Cardiology, The First Affiliated Hospital, China Medical University, Shenyang, PR China.
authors.forename: Hai-Jie
authors.initials: HJ
authors.lastname: Yu
authors.affiliation: Department of Cardiology, The First Affiliated Hospital, China Medical University, Shenyang, PR China.
authors.forename: Xin-Gang
authors.initials: XG
authors.lastname: Zhang
authors.affiliation: Department of Cardiology, The First Affiliated Hospital, China Medical University, Shenyang, PR China.
authors.forename: Feng
authors.initials: F
authors.lastname: Xu
authors.affiliation: Department of Cardiology, The First Affiliated Hospital, China Medical University, Shenyang, PR China.
authors.forename: Yue-Lan
authors.initials: YL
authors.lastname: Zhang
authors.affiliation: Department of Cardiology, The First Affiliated Hospital, China Medical University, Shenyang, PR China.
authors.forename: Da-Lin
authors.initials: DL
authors.lastname: Jia
authors.affiliation: Department of Cardiology, The First Affiliated Hospital, China Medical University, Shenyang, PR China.
authors.forename: Ying-Xian
authors.initials: YX
authors.lastname: Sun
authors.affiliation: Department of Geriatric Cardiology, The First Affiliated Hospital, China Medical University, Shenyang, PR China.
authors.forename: Guo-Xian
authors.initials: GX
authors.lastname: Qi
authors.affiliation: Department of Geriatric Cardiology, The First Affiliated Hospital, China Medical University, Shenyang, PR China. Electronic address: dr_wentian@163.com.
authors.forename: Wen
authors.initials: W
authors.lastname: Tian
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality / Q000628:therapy; D000241:Adenosine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000368:Aged; D000077144:Clopidogrel; D015331:Cohort Studies; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D000077486:Ticagrelor; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D000077486:Ticagrelor; D000241:Adenosine; D013988:Ticlopidine
keywords: Acute coronary syndrome; Antiplatelet therapy; Clopidogrel; In-stent thrombosis; Target vessel revascularization; Ticagrelor