Coronary Artery Disease Clinical Trial
Official title:
Half-dose Ticagrelor Overcomes High-dose Clopidogrel in Acute Coronary Syndrome Patients With High On-Clopidogrel Platelet Reactivity
With the widespread use of clopidogrel, resistance to clopidogrel has been attracting
increasing attention, and emerged as a new challenge adversely affecting patients clinical
risk and outcome. Clopidogrel resistance means that blood platelets show little or no
response to clopidogrel. It is closely associated with increased risk of serious
cardiovascular events, seriously affects the prognosis of patients, and brings difficulties
to clinical treatment.
Guideline recommendations on the use of dual antiplatelet therapy have been formulated that
ticagrelor 90 mg twice daily plus aspirin in preference to clopidogrel 75mg daily plus
aspirin for ACS patients. Recent study found that ticagrelor 90mg twice a day orally could
significantly reduce the occurrence of clopidogrel resistance and adverse cardiovascular
events. The previous studies have reported that half-dose ticagrelor had the similar
inhibitory effect on platelet aggregation as the standard-dose ticagrelor, which was
significantly stronger than that in the clopidogrel group. But it is still not very clear
that the effect of low-dose ticagrelor on platelet function in patients with clopidogrel
resistance and coronary heart disease.
Therefore, we performed this randomized, single-blind clinical trial to observe the effects
of low-dose ticagrelor and double standard-dose clopidogrel on platelet aggregation and
prognosis in clopidogrel resistance's patients with coronary heart disease.
Dual Antiplatelet Therapy (DAPT) with aspirin and P2Y12 receptor inhibitor remains a
cornerstone in the secondary prevention of coronary artery disease (CAD). Clopidogrel is one
of the most commonly used antithrombotic agent that inhibits the platelet P2Y(12) adenosine
diphosphate (ADP) receptor. With the widespread use of clopidogrel, resistance to clopidogrel
has been attracting increasing attention, and emerged as a new challenge adversely affecting
patients clinical risk and outcome. Clopidogrel resistance means that blood platelets show
little or no response to clopidogrel. Recent studies have found that clopidogrel resistance
rate was about 11% ~ 44%. Clopidogrel resistance is more common in patients with
loss-of-function CYP2C19 genotypes, and closely associated with increased risk of serious
cardiovascular events, including ischemic events, myocardial infarction, stent thrombosis,
revascularization and so on. This seriously affects the prognosis of patients, and brings
difficulties to clinical treatment.
Ticagrelor is an oral, reversibly-binding, direct-acting P2Y12 receptor antagonist used
clinically for the prevention of atherothrombotic events in patients with acute coronary
syndromes (ACS). Guideline recommendations on the use of dual antiplatelet therapy have been
formulated that ticagrelor 90 mg twice daily plus aspirin in preference to clopidogrel 75mg
daily plus aspirin for ACS patients. Recent study found that ticagrelor 90mg twice a day
orally could significantly reduce the occurrence of clopidogrel resistance and adverse
cardiovascular events. The previous studies have reported that half-dose ticagrelor had the
similar inhibitory effect on platelet aggregation as the standard-dose ticagrelor, which was
significantly stronger than that in the clopidogrel group. But it is still not very clear
that the effect of low-dose ticagrelor on platelet function in patients with clopidogrel
resistance and coronary heart disease.
Therefore, we performed this randomized, single-blind clinical trial to observe the effects
of low-dose ticagrelor and double standard-dose clopidogrel on platelet aggregation and
cardiovascular prognosis in clopidogrel resistance's patients with coronary heart disease.
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