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Patients with stable coronary heart disease(CAD) undergoing percutaneous coronary intervention (PCI) frequently exhibit high platelet reactivity (HPR) while on clopidogrel. We aimed to test the hypothesis that HPR after standard treatment with clopidogrel, ticagrelor-standard dose (90 mg, twice one day) could be more effective than high-dose (150 mg/d) clopidogrel.
Consecutive patients with stable CAD undergoing PCI and loaded with clopidogrel were considered for platelet reactivity (PR) assessment at 24 hours after PCI with the 20μmol/L ADP -induced light transmittance aggregometry (LTA, Helena Laboratories, Beaumont City, USA) and VerifyNow assay (Accumetrics Inc, San Diego, CA), measured in maximum platelet agglutination (MPA) and P2Y12 reaction units (PRU). Of 655 screened patients, 40 (6.1%) were found with HPR (defined as MPA>=60% and PRU>=246, meanwhile) and participated in a prospective, randomized, single-center, crossover study of platelet inhibition by ticagrelor 90 mg twice a day vs clopidogrel 150 mg/d, with a 14-day treatment period.
The primary end point of MPA and PR at the end of the 2 study periods was lower in patients receiving standard-dose ticagrelor than those receiving high-dose clopidogrel (MPA: 26.59±10.79 vs 47.39±15.57, 25.15±11.75 vs 48.26±19.12; PRU: 76.20±52.51 vs 175.65±20.82, 86.55±44.38 vs 126.50±68.09, all p value were <0.001, respectively).
In patients with stable CAD undergoing PCI and exhibiting HPR after standard clopidogrel treatment, standard-dose ticagrelor 90 mg twice a day is significantly more efficacious than clopidogrel 150 mg/d in reducing MPA and PR.