The plasma concentration of ticagrelor and aspirin as a predictor of bleeding complications in Chinese ACS patients with dual antiplatelet therapy: A prospective observational study

Abstract Purpose: This study evaluated the association among the plasma concentration of ticagrelor, ARC124910XX, aspirin, and salicylic acid with the risk of recent bleeding in patients with the acute coronary syndrome. To this end, we developed an accurate model to predict bleeding. Methods: A total of 84 patients included in this study cohort between May 2021 and November 2021. The risk factors were identified by univariate and multivariate analyses, and statistically significant risk factors identified in the multivariate analysis were included in the nomogram. We used the calibration curve and the receiver operating characteristic (ROC) curve to verify the accuracy of the prediction model. Results: Multivariable logistic analysis showed that ticagrelor concentration (OR: 2.47, 95%CI: 1.51-4.75, P =0.002), ST-segment elevation acute myocardial infarction (STEMI, OR: 32.2, 95%CI: 2.37-780, P =0.016), and lipid-lowering drugs (OR: 11.52, 95%CI: 1.91-110, P =0.015) were positively correlated with bleeding. However, ACEI/ARB (OR: 0.04, 95%CI: 0.004-0.213, P <0.001) was negatively correlated with bleeding. The receiver operating characteristic curve analysis (ROC) showed that ticagrelor concentration and these factors together predict the occurrence of bleeding (AUC=0.945, 95%CI: 0.896-0.994) and that ticagrelor concentration > 694.90 ng/mL is the threshold of bleeding concentration (AUC=0.696, 95%CI: 0.558-0.834). Conclusion: In patients with acute coronary syndrome treated with dual antiplatelet therapy, ticagrelor concentration > 694.90 ng/mL was an independent risk factor for bleeding (OR: 2.47, 95% CI: 1.51-4.75, P =0.002), but ARC124910XX and salicylic acid concentration did not affect bleeding risk ( P >0.05).