Optimal strategy of switching from clopidogrel to ticagrelor in Chinese acute coronary syndrome patients with complicated coronary artery disease: the switching from clopidogrel to ticagrelor (SHIFT-CACS) study

作     者：Ying Yao Ping Wang Xiao-Zeng Wang Xin Zhao Wei Zhao Tie-Nan Zhou Lei Zhang Yao Ying;Wang Ping;Wang Xiao-Zeng;Zhao Xin;Zhao Wei;Zhou Tie-Nan;Zhang Lei

作者机构：Department of CardiologyInstitute of Cardiovascular ResearchGeneral Hospital of Northern Theater CommandShenyangLiaoning 110840China Department of Clinical PharmacyShenyang Pharmaceutical UniversityShenyangLiaoning 110016China 

出 版 物：《Chinese Medical Journal》 (中华医学杂志（英文版）)

年 卷 期：2019年第132卷第19期

页      面：2292-2299页

核心收录：

学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

基　　金：supported by a grant from the National Key Research and Development Project 

主　　题：Clopidogrel Drug substitution Pharmacology Ticagrelor 

摘      要：Background:The dose and time point for switching from clopidogrel to ticagrelor remain controversial,especially for Chinese acute coronary syndrome(ACS)patients with complicated coronary artery disease(CAD).Hence,the purpose of this study was to further explore the optimal dose and time point for the switching strategy to balance the increase in platelet inhibition and the decrease in adverse events in Chinese ACS patients with complicated CAD managed by percutaneous coronary intervention(PCI).Methods:From July 2017 to December 2017,the prospective,randomized,open-label study(the SwitcHIng from clopidogrel to ticagrelor study)assigned the eligible Chinese ACS patients with complicated CAD managed by PCI(n=102)for 90 mg of ticagrelor at 12 h(T-90 mg-12 h),90 mg of ticagrelor at 24 h(T-90 mg-24h)or 180 mg ticagrelor at 24 h(T-180 mg-24 h)after the last dose of *** primary endpoint was the comparison of maximal platelet aggregation(MPA)values at 2 h after switching strategies among the three *** addition,the MPA values at baseline,8 h and before discharge and the rates of high ontreatment platelet reactivity were evaluated,the incidences of bleeding episodes and dyspnea during hospitalization and at 30-day follow-up in our study were also *** MPA was measured by light transmittance aggregometry in our study.A repeatedmeasures analysis of variance(ANOVA)model and one-way ANOVA were used to compare data for the primary ***:The MPA values were significantly decreased in the T-180 mg-24 h group compared with the T-90 mg-12 h group(P=0.017)and decreased numerically compared with the T-90 mg-24 h group(P=0.072)at 2 *** particular,the MPA values were markedly reduced in the T-90 mg-24 h group compared with the T-90 mg-12 h group at 8 h after switching treatment(P=0.002).There was no significant difference among the three groups in all bleedings and dyspnea ***:The optimal treatment strategy recommended in this study for