Efficacy and safety of dual antiplatelet prolongation therapy after PCI in ACS patients guided by DAPT scoring system

Objective To investigate the efficacy and safety of extended treatment for one year with different doses of clopidogrel plus aspirin after percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS) based on dual antiplatelet therapy (DAPT) scoring system. Methods From April 2016 to December 2016, 225 patients with ACS, one year after successfully undergoing PCI and with ≥2 of DAPT score were enrolled in present study, and randomly divided into 3 groups (75 each): control group, observation group A and observation group B. Patients in control group were given aspirin enteric tablet 100mg qd, in observation group A were given aspirin 100mg qd plus clopidogrel 75mg qd, and in observation group B were given aspirin 100mg qd plus clopidogrel 50mg qd. All patients were followed up for one year, the incidence of cardio- and cerebrovascular events and bleeding events were observed and compared among the 3 groups. At the same time, the ADP-induced platelet aggregation rate and the platelet function (MA) from thromboelastography (TEG) pre- and post-treatment were analyzed. Results During the 12-month observation period, the overall incidence of cardiovascular events showed statistical differences among control group, observation groups A and B (21.3% vs. 5.3% vs. 5.3%, P<0.05), the incidence was higher in control group than in groups A and B (P<0.05), but no difference between group A and group B (P>0.05). In control group, observation groups A and B, the incidences of mild bleeding (BARC1+2) (2.6% vs. 12.0% vs. 3.9%) and total bleeding events (2.6% vs. 13.3% vs. 3.9%) showed statistical differences (P<0.05), and was significantly higher in observation group A than in control group and observation group B (P<0.05). In the control group, the ADP-induced platelet aggregation rate and the MA value increased significantly after treatment [(55.4±15.2)% and (53.8±4.8)mm] than that before treatment [(33.2±11.3)% and (44.8±4.2)mm, P<0.05]. However, there was no statistically significant difference in the ADP-induced platelet aggregate and MA value between observation groups A and B pre- and post-treatment (P>0.05). The platelet aggregation rate and platelet function (MA) in observation groups A and B decreased significantly than that in control group one year after prolonged antiplatelet therapy (P<0.05). Conclusions Assessment of ischemia risk with DAPT scoring system in patients with ACS, prolonged clopidogrel plus aspirin therapy for those patients with DAPT score ≥2 could reduce the incidence of major cardiovascular events, and low dose clopidogrel dose not increase the risk of bleeding complications.\n\t\t\n\t\tDOI: 10.11855/j.issn.0577-7402.2019.01.07