Clopidogrel versus ticagrelor in elective percutaneous coronary intervention
Recent guidelines revealed that patients with stable coronary artery disease (SCAD) benefit from percutaneous coronary intervention (PCI) with the placement of the stent, and this procedure is the best if medical treatment fails to improve the patient's condition. Oral antiplatelet drugs, particularly aspirin coupled with adenosine diphosphate (ADP) receptor blocking agents represent a crucial component of therapy for these patients to reduce the risk of ischemic events. This work aims to compare the clinical safety and efficacy of clopidogrel versus ticagrelor in patients undergoing elective PCI with the determination of actual plasma concentrations and the platelet inhibitory effect of both drugs with the help of ultra-high-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) and light transmission aggregometry (LTA) respectively. A total of 60 patients diagnosed with SCAD were enrolled in this study and scheduled for PCI. In addition to aspirin, half of the Patients received clopidogrel, 600 mg loading dose, and 75mg daily after PCI. The other thirty patients received ticagrelor at a loading dose of 180mg and 90 mg twice daily thereafter. Ticagrelor reduced the occurrence of major adverse cardiac events (MACE) but this reduction was not significant compared to clopidogrel. Meanwhile, it was associated with an increased risk of major bleeding and dyspnea. There was inter-individual variability in clopidogrel plasma concentration. Ticagrelor showed a significant reduction in the maximal ADP-induced platelet aggregation in comparison with clopidogrel. In patients undergoing elective PCI, ticagrelor was involved in lowering the MACE at the expense of increased major bleeding and dyspnea compared to clopidogrel.
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