Comparison of Treatment Outcomes of Ticagrelor and Clopidogrel among Patients Undergoing Percutaneous Coronary Intervention: A Meta-analysis

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.

Ticagrelor therapy and atrioventricular block:Do we need to worry?

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.

Alternatives to clopidogrel for acute coronary syndromes:Prasugrel or ticagrelor?

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.

Ticagrelor versus clopidogrel in East Asian patients with acute coronary syndrome:A meta-analysis

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.

Comparison of Clinical Efficacy of Ticagrelor and Clopidogrel for Treatment of Coronary Heart Disease with Myocardial Ischemia

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.

Effect of ticagrelor sequential therapy after PCI on platelet function and cytokine secretion in patients with ACS

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.

Effect of ticagrelor and clopidogrel on serum inflammatory factor level in antiplatelet therapy for acute myocardial infarction patients after percutaneous coronary intervention

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.

Effects of different doses of ticagrelor on coronary blood flow, inflammatory response and myocardial enzyme spectrum in patients with acute myocardial infarction

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.

Effects of Ticagrelor on oxidative stress, coagulation function, platelet function and related factors in patients with coronary artery disease undergoing interventional therapy

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.

Influence of ticagrelor on platelet function, plaque properties and inflammatory response in patients with acute coronary syndrome complicated by clopidogrel resistance

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.

Study of the influence and molecular mechanism of ticagrelor on cerebral ischemia reperfusion injury in rats

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.

The impact analysis of the oxidative stress injury and inflammatory factor level for ticagrelor assisted PCI in the treatment the elderly patients with ST segment elevation acute myocardial infarction

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).

Impact of concomitant use of proton pump inhibitors and clopidogrel or ticagrelor on clinical outcomes in patients with acute coronary syndrome

BackgroundThere 是在质子泵禁止者(PPI ) 和 clopidogrel 之间的可能的不利相互作用上的大争论。另外， PPI 的使用是否少些影响 ticagrelor 遗体的临床的功效，知道。在经皮的冠的干预(一种总线标准) .MethodsWe 回顾地从 “ 分析了数据以后，我们试图与急性冠的症候群(交流)在病人在临床的结果上决定 PPI 和 clopidogrel 或 ticagrelor 的伴随物管理的影响；真实 world” ；，国际，在 2003 和 2014 之间的多中心登记( n = 15,401 )并且在1年的合成主要端点上估计了 PPI 和 clopidogrel 或 ticagrelor 的伴随物管理的影响(所有原因死亡收到 PPI 的病人更老，更经常女性，并且是更可能的有 comorbidities。没有协会为收到 clopidogrel 的病人在 PPI 使用和主要端点之间被观察(调整 HR：1.036；95% CI：0.903-1.189 ) 或 ticagrelor (调整 HR：2.320；95% CI：0.875-6.151 )(P 相互作用 = 0.2004 ) 。同样， PPI 的使用没与所有原因死亡，重新梗塞，或与交流后面的一种总线标准的为与任何一个 clopidogrel 对待的病人或 ticagrelor.ConclusionsIn 病人的严重流血的减少的风险的增加的风险被联系， PPI 的伴随物使用没在收到 clopidogrel 或 ticagrelor 的病人与不利结果的增加的风险被联系。我们的调查结果显示与 clopidogrel 或 ticagrelor 在联合使用 PPI 是合理的，特别在有胃肠的流血的更高的风险的病人。

Relationship between ADP-induced platelet-fibrin clot strength and anti-platelet responsiveness in ticagrelor treated ACS patients

BackgroundTicagrelor 提供提高的 antiplatelet 功效但是流血和呼吸困难的增加的风险。这研究试图显示在导致自动数据处理的血小板血纤维蛋白块力量之间的关系(麻省 在病人们由收到了维护的有交流的中国汉的病人在阿司匹林上 ticagrelor 开的 ticagrelor.MethodsConsecutive 治疗了的急性冠的症候群(交流) 的自动数据处理 ) 和临床的结果被招募。在 5 天的 ticagrelor 维护治疗以后，麻省 thrombelastography (两岁的羊) 测量的自动数据处理 为 ticagrelor 反血小板的评估被记录反应。麻省 自动数据处理 >；为高在处理上血小板反应(HTPR ) 和麻省 自动数据处理 <；为低在处理上血小板反应(LTPR ) 的 31 公里被申请评估。主要 ischemic 的出现心血管的事件(包括一心脏的死亡，非致命的心肌的梗塞和击合成) ，在心肌的梗塞(TIMI ) 的 Thrombolysis 定义流血事件，和 ticagrelor 相关呼吸困难在三 months.ResultsOverall 的后续以后被记录， 176 个交流病人(男性：79.55% ，变老：59.91 ±；10.54 年) 在 ticagrelor 下面，维护治疗被招募。麻省 自动数据处理 从 4.80% ～ 72.90%(21.27%±；12.07% 平均) ，与更高向更低的价值扭曲的分发。用为 HTPR 和 LTPR 的 pre 特定的截止，七个病人(3.98%) 作为 LTPR 作为 HTPR 和 144 个病人(81.82%) 被识别。在在 172 个病人的三个月的后续以后，主要心血管的事件在三个病人与主要流血在在 81 为事件放血的没有病人，而是 TIMI (47.09%) 发生了。有主要流血的所有病人作为 LTPR 被分类。 Ticagrelor 相关呼吸困难发生在 31 (18.02%)病人，(21.28%)作为 HTPR 作为 LTPR 和没有人与 30 分类( P = 0.02 ) .ConclusionsIn ticagrelor 对待交流病人，麻省 两岁的羊测量的自动数据处理可能为主要流血和 ticagrelor 的预言是珍贵的相关呼吸困难。由于有在 ticagrelor 维护治疗以后的 HTPR 的病人的小数字，更大的规模学习应该被保证验证在麻省 自动数据处理 定义 HTPR， ticagrelor 联系了 ischemic 事件。

老年急性ST段抬高型心肌梗死患者经皮冠状动脉介入治疗后延长应用替格瑞洛对临床转归的影响

目的探讨老年(年龄≥65岁)急性ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入治疗(PCI)后延长应用替格瑞洛对临床转归的影响。方法纳入2018年2月至2021年2月在秦皇岛市第一医院行PCI后接受替格瑞洛+阿司匹林双联抗血小板治疗(DAPT)的≥65岁急性STEMI患者105例(应用DAPT评分系统评估均≥2分),在阿司匹林长期用药基础上,根据患者服用替格瑞洛时间不同分为对照组(n=37,使用时间为PCI治疗后1年)与观察组(n=68,在对照组基础上再延长替格瑞洛治疗1年),其中观察组根据延长应用替格瑞洛的剂量不同又分为2个亚组,即观察A组(n=40,标准剂量,90 mg/次,每日2次)和观察B组(n=28,小剂量,45 mg/次,每日2次)。比较3组患者急诊PCI术后心肌梗死溶栓治疗(TIMI)3级血流、心电图完全回落比例、血栓弹力图中的血小板功能(MA)、二磷酸腺苷诱导的血小板聚集率;随访1年,主要不良心脑血管事件(MACCE)、出血事件发生情况。采用SPSS 25.0软件进行数据分析。根据数据类型,组间比较采用t检验、χ^(2)检验。结果PCI术后,观察A、B组的TIMI 3级血流患者比例显著高于对照组(χ^(2)=4.699、4.353;P=0.030、0.036),而观察A组与观察B组组间差异无统计学意义。PCI治疗后2年,观察A、B组血栓弹力图中的MA值、二磷酸腺苷诱导的血小板聚集率明显低于对照组(t=8.752、6.524;均P<0.001),但观察A组、观察B组比较差异无统计学意义。随访1年,3组总MACCE发生率比较差异有统计学意义(χ^(2)=4.354;P=0.039),其中观察组A、B组MACCE发生率均显著低于对照组(χ^(2)=4.769、5.082;P=0.028、0.024),但观察A组与观察B组间差异无统计学意义;3组患者出血事件发生率差异均无统计学意义。结论老年(≥65岁)STEMI患者(DAPT评分≥2分)PCI后延长应用替格瑞洛可能降低主要不良心脑血管事件发生率,且小剂量(45mg/次)替格瑞洛并未增加出血发生的风险,仍需长期随访观察进一步证实。

丁苯酞联合替格瑞洛对缺血性脑血管病患者的疗效

目的探讨丁苯酞联合替格瑞洛对缺血性脑血管病(ICD)患者的疗效及对心理状态、认知功能的影响。方法选取2020年1月至2022年1月新乡市中心医院收治的120例ICD患者为研究对象,并通过随机数字表法分为对照组(60例)、联合组(60例)。所有患者均接受常规治疗,对照组接受替格瑞洛治疗,联合组接受替格瑞洛联合丁苯酞治疗。治疗2周,对比两组疗效、心理状态、神经功能、认知功能、血清学指标[降钙素基因相关肽(CGRP)、同型半胱氨酸(Hcy)]及药物不良反应(ADR)情况。结果联合组总有效率为93.33%,较对照组的80.00%高(P<0.05);两组治疗2周后汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)评分、神经功能缺损(NDF)量表评分及血清Hcy水平均较治疗前低(P<0.05),联合组低于对照组(P<0.05);两组治疗2周后蒙特利尔认知功能评定表(MoCA)评分及血清CGRP水平均较治疗前高(P<0.05),联合组高于对照组(P<0.05);联合组、对照组ADR分别为8.33%、5.00%,组间比较差异无统计学意义(P>0.05)。结论对ICD患者应用丁苯酞联合替格瑞洛治疗,疗效较佳,可调节血清CGRP、Hcy水平,改善神经功能、认知功能,减轻负面心理,且ADR较少。

冠心病合并慢性肾病经皮冠状动脉介入术后替格瑞洛应用的系统性评价

目的系统评价冠心病合并慢性肾病经皮冠状动脉介入术(PCI)后患者使用替格瑞洛的有效性和安全性。方法计算机检索中国知网、万方、维普、PubMed、Web of Science、Embase、Cochrane Library数据库。根据Cochrane系统评价手册和纽卡斯尔-渥太华量表(NOS)对纳入研究的质量进行评价。采用Stata 15.0软件进行Meta分析。结果共纳入了10项研究,涉及4项随机对照试验和6项队列研究,合计8110例冠心病合并慢性肾病PCI术后患者,试验组3356例,对照组4754例。Meta分析结果显示:在有效性方面,两组患者不良心脑血管事件(MACCE)(OR=0.78,95%CI:0.68~0.89,P<0.001)、心肌梗死发生率(OR=0.76,95%CI:0.62~0.93,P<0.001)比较,差异均有统计学意义;两组患者全因死亡(OR=0.81,95%CI:0.59~1.10,P=0.179)、心源性死亡(OR=0.76,95%CI:0.54~1.05,P=0.542)、卒中(OR=0.87,95%CI:0.65~1.17,P=0.354)、重复血运重建发生率(OR=0.73,95%CI:0.51~1.04,P=0.077)比较,差异无统计学意义。在安全性方面,两组患者出血发生率(OR=1.12,95%CI:0.85~1.46,P=0.432)比较,差异无统计学意义。结论应用替格瑞洛治疗冠心病合并慢性肾病PCI术后患者,全因死亡、心源性死亡、卒中、重复血运重建发生率与对照组相比疗效相当,但是替格瑞洛可有效降低MACCE、心肌梗死的发生率,且不增加出血风险。

替格瑞洛递减联合尼可地尔对老年急性冠脉综合征PCI术后干预的有效性和安全性

目的探索老年急性冠脉综合征(ACS)患者经皮冠状动脉介入(PCI)术后替格瑞洛递减治疗与尼可地尔联合干预的有效性和安全性。方法纳入2016年11月-2019年6月于解放军总医院第六、第七医学中心及北京朝阳中西医结合急诊抢救医院诊治的300例老年ACS患者,男153例,女147例,年龄>65岁,所有患者均接受PCI治疗,均为双联抗血小板治疗(DAPT)评分≥2分,新型DAPT评分(PRECISE-DAPT)≥25分的老年患者。所有患者术前采用随机数字表法分为替格瑞洛组(n=146,给予替格瑞洛180 mg负荷剂量后行PCI,术后给予替格瑞洛90 mg bid)与替格瑞洛递减+尼可地尔组(n=154,给予替格瑞洛180 mg负荷剂量后行PCI,术后给予替格瑞洛90 mg bid+尼可地尔5 mg tid,6个月后改为替格瑞洛60 mg bid+尼可地尔5 mg tid)。随访12个月。观察两组患者12个月内出现的心血管死亡、心肌梗死、卒中的复合终点,PLATO研究定义轻微出血、次要出血、其他主要出血和主要致命/危及生命的出血的复合终点,以及心血管死亡、心肌梗死、卒中与出血的复合终点。结果两组患者一般基线资料比较差异均无统计学意义(P>0.05);两组心血管死亡、心肌梗死、卒中的复合终点差异无统计学意义(P>0.05)。而替格瑞洛递减+尼可地尔组出血事件的累积发生率明显低于替格瑞洛组(P<0.05);心血管死亡、心肌梗死、卒中与出血事件的复合终点也明显低于替格瑞洛组(P<0.05)。结论老年ACS患者PCI术后替格瑞洛递减+尼可地尔治疗可不增高心血管死亡、心肌梗死及卒中等缺血性事件的发生率,且可降低出血性事件的发生率。

替格瑞洛对血清尿酸水平的影响及其机制的研究进展

高尿酸血症是导致心血管疾病患者预后不良的重要原因。研究表明,替格瑞洛会引起不同程度的血清尿酸水平升高,可能与肾尿酸转运体功能障碍和红细胞腺苷再摄取减少相关。本文就替格瑞洛引起尿酸升高的发生率、危险因素和潜在机制等研究现状进行综述,旨在为替格瑞洛相关高尿酸血症的防治提供策略。

气相色谱-质谱法测定替格瑞洛中间体中基因毒性杂质1-溴丙烷

建立气相色谱-质谱法测定替格瑞洛中间体[4,6-二氯-2-(丙硫基)-5-氨基嘧啶(DCPA)]中潜在基因毒性杂质1-溴丙烷。样品以N,N-二甲基甲酰胺溶解后直接进样,经Agilent DB-5MS毛细管色谱柱(30 m×0.25 mm,0.25μm)分离,采用选择离子扫描(SIM)模式定量分析。1-溴丙烷的质量浓度在131.8~1 758 ng/mL范围内与色谱峰面积线性关系良好,相关系数为0.999 8,检出限为0.40μg/g,定量限为1.32μg/g。样品加标平均回收率为91.8%,测定结果的相对标准偏差为2.9%(n=6)。该方法简单便捷、专属性强、灵敏度高,可为卤代烃类基因毒性杂质的痕量检测提供方法参考。