Clopidogrel versus ticagrelor in the treatment of Chinese patients undergoing percutaneous coronary intervention: effects on platelet function assessed by platelet function tests and mean platelet volume

Yang Zhang; Rui Peng; Xiaojuan Li; Gaowa Cheng; Ximing Wang; Jinxing Yu; Muxing Hua; Xi Chen; Zhou Zhou

doi:10.1186/s12959-021-00350-2

Clopidogrel versus ticagrelor in the treatment of Chinese patients undergoing percutaneous coronary intervention: effects on platelet function assessed by platelet function tests and mean platelet volume

Thromb J. 2021 Dec 7;19(1):97. doi: 10.1186/s12959-021-00350-2.

Authors

Yang Zhang^#¹, Rui Peng^#¹, Xiaojuan Li², Gaowa Cheng¹, Ximing Wang¹, Jinxing Yu¹, Muxing Hua², Xi Chen³, Zhou Zhou⁴

Affiliations

¹ Diagnostic Laboratory Service, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, No.167, Beilishi Road, Xicheng District, Beijing, 100037, China.
² Department of Laboratory Medicine, Yunnan Fuwai Cardiovascular Hospital, Kunming, 650000, China.
³ Diagnostic Laboratory Service, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, No.167, Beilishi Road, Xicheng District, Beijing, 100037, China. chenxifw@pumc.edu.cn.
⁴ Diagnostic Laboratory Service, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, No.167, Beilishi Road, Xicheng District, Beijing, 100037, China. zhouzhou@fuwaihospital.org.

^# Contributed equally.

Abstract

Background: Knowledge on the pharmacodynamic effects of antiplatelet drugs including clopidogrel and ticagrelor on Asian patients is scarce. We aim to evaluate the effects of the two drugs on platelet reactivity in the treatment of Chinese patients who underwent percutaneous coronary intervention (PCI), using two platelet function tests (PFT). Meanwhile, the relationship between mean platelet volume (MPV), a routine index of platelet size, and high on-treatment platelet reactivity (HPR) is also investigated.

Methods: Patients receiving dual antiplatelet therapy (DAPT) were scheduled for the assessment of platelet reactivity at 2-3 days after PCI. Two PFTs, light transmission aggregometry (LTA) and vasodilator-stimulated phosphoprotein (VASP)-FCM assay, were applied in the evaluation of platelet reactivity. The MPV was measured simultaneously with EDTA plasma using a Sysmex XN 2000 automated hematology analyzer.

Results: The final study population included the aspirin + clopidogrel group (n = 46) and the aspirin + ticagrelor group (n = 66). In the aspirin + ticagrelor group, the maximal light transmittance (LT) changes in response to 5 μM ADP assessed by LTA was obviously lower than that in the aspirin + clopidogrel group (P < 0.001). The platelet reactivity index (PRI) level in the VASP test was also markedly lower in the group given aspirin and ticagrelor (P < 0.001). There was a significant difference in HPR between the two groups. MPV showed a potent ability to predict the presence of HPR at VASP assay (AUC = 0.788, 95% CI: 0.701-0.875, P < 0.001) in receiver-operating characteristic curve analysis.

Conclusions: Compared with clopidogrel, ticagrelor has dramatically greater antiplatelet effect, with a superiority in suppressing platelet function and a lower HPR rate. In addition, there existed a significant independent association between MPV and high prevalence of HPR in the VASP assay.

Keywords: Dual antiplatelet therapy; High on-treatment platelet reactivity; Mean platelet volume; Platelet function tests.