Comparison of Ticagrelor and Clopidogrel on Platelet Function and Prognosis of Patients with Unstable Angina

Abstract Objective To compare the effect of ticagrelor and clopidogrel on platelet inhibition and cardiovascular prognosis and bleeding in patients with unstable angina. Methods Patients diagnosed as unstable angina and undergoing successful PCI were selected from January 2016 to December 2018. Totally 212 patients received ticagrelor (90mg twice daily) and 210 received clopidogrel (75mg daily). Thrombo-elastography (TEG) and light transmission aggregometry (LTA) were used to measure platelet aggregation rate (PAR) induced by adenosine diphosphate (ADP) and arachidonic acid (AA). High-sensitivity troponin T (hs-TnT), pro-brain natriuretic peptide (NT-proBNP), high-sensitivity C-reactive protein (CRP) and heart-type fatty acid binding protein(H-FABP)were measured to assess myocardium injury peri-PCI. Patients were followed up in hospital and 12 months after discharge for cardiovascular prognosis and bleeding events. Results There were no significant differences in clinical characteristics between the two groups. Compared with clopidogrel, PAR in ticagrelor group was inhibited more significantly (P < 0.001). Hs-TnT, NT-proBNP, CRP, and h-FABP elevated post PCI in both groups (P < 0.05 vs. Pre-PCI in each group), of which hs-TnT (P < 0.001) and h-FABP (P < 0.001) in clopidogrel group elevated more significantly. Both MACE in hospital and at 12-months follow up showed no significant difference between the two groups. Total bleeding events were increased in hospital in ticagrelor group (P < 0.05). Both minor bleeding and total bleeding were significantly elevated at 12-month follow up in ticagrelor group (P < 0.05). Conclusions Ticagrelor was effective in platelet suppression than clopidogrel and reduced peri-PCI myocardial injury in patients with unstable angina. However, ticagrelor showed no advantages in reducing in hospital and 12-months MACE and increased in hospital and 12-months bleeding events.