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Updated: Aug 25, 2025
Microfluidics in Assessing Platelet Function
Published on: November 8, 2024
Comparison of ticagrelor and clopidogrel on platelet function and prognosis in unstable angina
Chun Li1, Ming Liu1, Weixiang Chen1
1Department of Cardiovascular Medicine, First Affiliated Hospital of Soochow University, Suzhou, 215006, China.
Insights
Ticagrelor better inhibited platelet aggregation and reduced myocardial injury in unstable angina patients post-PCI than clopidogrel. However, ticagrelor increased bleeding events without improving major adverse cardiovascular events.
Area of Science:
- Cardiology
- Pharmacology
- Interventional Cardiology
Background:
- Unstable angina pectoris (UAP) is a critical condition requiring prompt management.
- Antiplatelet therapy is crucial in patients with UAP undergoing percutaneous coronary intervention (PCI).
- Ticagrelor and clopidogrel are commonly used P2Y12 inhibitors, but their comparative effectiveness and safety profiles require further elucidation.
Purpose of the Study:
- To compare the efficacy of ticagrelor versus clopidogrel in suppressing platelet function.
- To evaluate the impact of these agents on myocardial injury markers post-PCI.
- To assess differences in cardiovascular prognosis and bleeding events between the two treatment groups.
Main Methods:
- A prospective study involving 422 patients with UAP undergoing PCI.
- Patients received either ticagrelor (90 mg twice daily) or clopidogrel (75 mg once daily).
- Platelet aggregation rate (PAR) was measured using thromboelastography and light transmission aggregometry. Biomarkers for myocardial injury and clinical outcomes were assessed.
Main Results:
- Ticagrelor significantly reduced PAR compared to clopidogrel (P < 0.001).
- Ticagrelor demonstrated a greater reduction in myocardial injury markers (hs-TnT, h-FABP) post-PCI.
- While MACE rates were similar, ticagrelor was associated with higher in-hospital and 12-month bleeding event rates.
Conclusions:
- Ticagrelor exhibits superior platelet inhibition and reduces PCI-induced myocardial injury more effectively than clopidogrel in UAP patients.
- Despite enhanced antiplatelet effects, ticagrelor is associated with an increased risk of bleeding.
- Neither agent demonstrated a significant advantage in reducing major adverse cardiovascular events in this cohort.
Purpose:
This study aims to compare the effects of ticagrelor and clopidogrel on platelet function, cardiovascular prognosis, and bleeding in patients with unstable angina pectoris.
Methods:
Patients with unstable angina pectoris undergoing percutaneous coronary intervention (PCI) were enrolled (January 2018-December 2019). In total, 212 patients were treated with ticagrelor (90 mg twice daily) and 210 patients were treated with clopidogrel (75 mg once daily). Thromboelastography and light transmission aggregometry were used to measure the platelet aggregation rate (PAR). High-sensitivity troponin T (hs-TnT), pro-brain natriuretic peptide (NT-proBNP), high-sensitivity C-reactive protein (CRP), and heart-type fatty acid-binding protein (h-FABP) were measured to assess myocardial injury after PCI. Cardiovascular prognosis and bleeding events were evaluated in hospital and 12 months after discharge.
Results:
The PAR was significantly slower with ticagrelor (P < 0.001). hs-TnT, NT-proBNP, CRP, and h-FABP increased after compared with before PCI in both groups (P < 0.05). hs-TnT (P < 0.001) and h-FABP (P < 0.001) increased more significantly with clopidogrel. The in-hospital and 12-month major adverse cardiovascular event (MACE) rates were not significantly different between the two groups. The in-hospital total bleeding event rate was higher with ticagrelor (P < 0.05). Minor bleeding and total bleeding were more frequent at the 12-month follow-up in the ticagrelor group (P < 0.05).
Conclusion:
Ticagrelor was more effective in suppressing the PAR than clopidogrel and reduced PCI-induced myocardial injury in patients with unstable angina pectoris. However, it increased in-hospital and 12-month bleeding events and had no benefit on in-hospital and 12-month MACEs.
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