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

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.

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.

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

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.

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).

阿司匹林联合替格瑞洛治疗冠心病不稳定型心绞痛的疗效及对患者心室重塑、氧化应激的影响

目的 观察阿司匹林联合替格瑞洛治疗冠心病不稳定心绞痛的疗效,并评估其对患者心室重塑、氧化应激等指标的影响。方法 选取2021年10月至2023年10月期间新乡市中心医院收治的186例冠心病不稳定心绞痛患者纳入研究,采用随机数表法分为观察组和对照组,每组93例。对照组患者采用阿司匹林联合氢氯吡格雷片治疗,观察组患者采用阿司匹林联合替格瑞洛治疗,均连续治疗3个月。比较两组患者的临床疗效,以及治疗前后的心室重塑[基质金属蛋白酶-9 (MMP-9)、半乳凝素-3 (Gal-3)]、血管内皮功能[血清细胞间黏附分子-1 (ICAM-1)、血管紧张素Ⅱ(AngⅡ)、内皮素-1 (ET-1)、血流介导舒张功能(FMD)水平]和氧化应激[一氧化氮(NO)、丙二醛(MDA)、超氧化物歧化酶(SOD)]水平。结果 观察组患者的治疗总有效率为96.77%,明显高于对照组的86.02%,差异有统计学意义(P<0.05);观察组患者治疗后的MMP-9水平为(141.28±19.33)μg/L,明显低于对照组的(164.72±19.86)μg/L,而Gal-3水平为(6.87±0.92) ng/mL,明显高于对照组的(5.36±0.84) ng/mL,差异均有统计学意义(P<0.05);观察组患者治疗后的ICAM-1、AngⅡ和ET-1水平分别为(56.87±9.70) pg/mL、(0.70±0.14) ng/mL和(43.15±5.83) pg/mL,明显低于对照组的(81.35±10.31) pg/mL、(0.96±0.15) ng/mL和(52.37±6.37) pg/mL,而FMD水平为(14.82±1.93)%,明显高于对照组的(11.27±2.33)%,差异均有统计学意义(P<0.05);观察组患者治疗后的NO、SOD水平分别为(77.95±9.60) mol/L、(112.69±11.47) U/L,明显高于对照组的(62.49±9.37) mol/L、(107.34±10.63) U/L,而MDA水平为(12.45±2.26) mmol/L,明显低于对照组的(15.38±2.35) mmol/L,差异均有统计学意义(P<0.05)。结论 阿司匹林联合替格瑞洛治疗不稳定型冠心病疗效确切,且能促进患者的心室重塑、改善血管内皮功能及氧化应激指标。

氯吡格雷联合替格瑞洛对急性ST段抬高型心肌梗死患者OCT指标的影响

目的基于光学相干断层成像(OCT)指标探讨氯吡格雷联合替格瑞洛对急性ST段抬高型心肌梗死(STEMI)患者动脉粥样硬化斑块稳定性的影响。方法回顾性选取江苏省滨海县人民医院2020年1月至2023年1月收治的急性STEMI患者105例,根据治疗方案的不同分为常规组(52例)和联合组(53例)。两组患者均予氯吡格雷治疗,联合组患者加用替格瑞洛,均治疗12个月。结果联合组患者的总有效率为84.91%,显著高于常规组的65.38%(P<0.05)。治疗后,联合组患者的最小纤维帽厚度显著大于常规组(P<0.05),脂质弧度显著小于常规组(P<0.05),且联合组的改善幅度均显著大于常规组(P<0.05);两组患者的最小管腔面积无显著差异(P>0.05),但联合组最小管腔面积增大量显著高于常规组(P<0.05);两组患者的全血黏度、血浆黏度、血细胞比容均显著降低(P<0.05),且联合组均显著低于常规组(P<0.05)。联合组患者的不良反应发生率为5.66%,显著低于常规组的19.23%(P<0.05)。结论氯吡格雷联合替格瑞洛治疗急性STEMI的临床疗效良好,可改善患者动脉粥样硬化斑块的稳定性,促进血管功能恢复,且安全性良好。

不同剂量替格瑞洛治疗ST段抬高型心肌梗死患者的有效性和安全性:基于倾向性评分匹配

背景双联抗血小板治疗是接受直接经皮冠状动脉介入治疗(PPCI)的ST段抬高型心肌梗死(STEMI)患者治疗的基础。阿司匹林联合替格瑞洛是STEMI患者抗血小板治疗的首选方案,与氯吡格雷相比,其能够更快、更有效地抑制血小板,并改善预后。但是尚缺乏在接受PPCI治疗的STEMI患者中应用减量替格瑞洛的研究。目的基于倾向性评分匹配(PSM)的方法,对比分析不同剂量替格瑞洛治疗STEMI患者的有效性和安全性。方法连续选取2019年6月—2021年5月在河北医科大学第二医院心血管内五科行PPCI并接受替格瑞洛治疗的STEMI患者为研究对象。根据应用替格瑞洛的维持剂量将患者分为减量组(60例:替格瑞洛60 mg/次,2次/d)和标准组(180例:替格瑞洛90 mg/次,2次/d)。采用PSM法对两组患者进行1∶1匹配,匹配变量包括性别、年龄、既往病史、入院时Killip分级和介入治疗相关参数等,最终减量组和标准组各纳入54例患者。分别于出院1、3、6个月时,对两组患者进行随访,记录和比较两组患者血小板功能相关参数和临床事件的发生情况。结果PSM后两组患者基线资料、介入治疗参数和住院期间主要不良心血管事件发生率比较,差异均无统计学意义(P>0.05)。基线时,两组患者血小板计数(PLT)、平均血小板体积(MPV)、血小板分布宽度(PDW)比较,差异均无统计学意义(P>0.05);减量组患者血小板聚集率(PAR)低于标准组(P<0.05)。出院时,减量组患者MPV高于标准组,PDW低于标准组(P<0.05)。出院1个月时,两组患者PLT、MPV、PDW、PAR比较,差异均无统计学意义(P>0.05)。出院3个月时,减量组患者PDW高于标准组(P<0.05)。出院6个月时,减量组患者MPV高于标准组(P<0.05)。减量组患者出院前后PLT、PAR比较,标准组患者出院前后PLT、PDW比较,差异均无统计学意义(P>0.05)。减量组、标准组患者出院时MPV高于基线,减量组患者出院时PDW低于基线,标准组患者出院时PAR低于基线(P<0.05)。减量组患者出院1、3、6个月MPV低于出院时,PDW高于出院时(P<0.05);标准组患者1、3、6个月PAR低于基线,高于出院时(P<0.05)。两组患者随访期间主要不良心血管事件、严重出血事件发生率比较,差异均无统计学意义(P>0.05)。结论在接受PPCI的STEMI患者中替格瑞洛60 mg治疗是安全有效的。

比索洛尔联合替格瑞洛对急性心肌梗死患者PCI术后Galectin-3、CEACAM 1水平的影响

目的:探究比索洛尔联合替格瑞洛对急性心肌梗死(AMI)患者经皮冠状动脉介入治疗(PCI)术后半乳糖凝集素-3(Galectin-3)、癌胚抗原相关细胞黏附分子1(CEACAM1)水平的影响。方法:选择2019年5月~2021年6月在我院接受PCI术的140例AMI患者。根据抛硬币法分为对照组70例和联合组70例,两组均使用阿司匹林,对照组在此基础上使用替格瑞洛,联合组使用替格瑞洛联合比索洛尔,均治疗2周。比较两组治疗前后Galectin-3、CEACAM1、血清N末端B型利钠肽前体(NT-proBNP)、肿瘤坏死因子-α(TNF-α)、一氧化氮(NO)、内皮素-1(ET-1)、丙二醛(MDA)水平,治疗效果以及不良反应情况。结果:与对照组治疗后比较,联合组Galectin-3[(34.67±2.34)ng/L比(28.54±1.92)ng/L]、CEACAM1[(229.64±17.36)pg/ml比(175.54±11.97)pg/ml]、NT-proBNP[(196.49±20.83)ng/L比(103.46±16.35)ng/L]、TNF-α[(5.68±0.72)mg/L比(3.23±0.57)mg/L]、ET-1[(59.47±4.74)ng/L比(45.29±3.84)ng/L]、MDA[(8.42±0.96)μmol/L比(5.03±0.46)μmol/L]水平均显著降低,NO水平[(72.34±5.69)μmol/L比(92.16±6.61)μmol/L]显著升高(P均<0.001)。联合组总有效率(94.29%比75.71%)显著高于对照组(P=0.002),而不良反应发生率(1.43%比14.29%)显著低于对照组(P=0.005)。结论:替格瑞洛联合比索洛尔可以显著降低AMI患者Galectin-3、CEACAM1水平,提高患者的治疗有效率且安全性良好,值得推广应用。

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。

替格瑞洛联合盐酸替罗非班对脑卒中患者的作用效果

目的探究替格瑞洛联合盐酸替罗非班对脑卒中患者的作用效果。方法选取152例脑卒中患者被随机分为对照组和观察组,每组76例。对照组接受替格瑞洛治疗,观察组接受盐酸替罗非班联合替格瑞洛治疗。比较两组患者神经功能、血流变化、血小板参数、血小板标志物、不良反应。结果治疗后两组神经功能、国立卫生研究院卒中量表(NIHSS)评分降低,Barthel指数(BI)升高(P<0.05)。观察组的NIHSS评分低于对照组(P<0.01),BI指数高于对照组(P<0.01)。治疗后,两组CD62P、CD63阳性率和P-selectin、血小板黏附性(PADT)和血小板聚集率(PAGT)水平下降(P<0.05),且观察组均低于对照组(P<0.05)。术后3个月的随访中,观察组患者不良心血管事件的发生率低于对照组(P<0.05)。结论替格瑞洛联合盐酸替罗非班可改善脑卒中患者神经功能、提高日常生活能力、降低血小板活动性以及减少主要不良心血管事件的发生率。