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The effect of antiplatelet drug on coronary endothelial and microvascular function: comparison with ticagrelor and clopidogrel

Korean Journal of Internal Medicine 2021년 36권 2호 p.352 ~ 361
최웅길, 김기창, 이철호, 김혜영, 김동운,
소속 상세정보
최웅길 ( Choi Woong-Gil ) - Konkuk University School of Medicine Department of Internal Medicine
김기창 ( Kim Gi-Chang ) - Konkuk University School of Medicine Department of Internal Medicine
이철호 ( Lee Cheol-Ho ) - Konkuk University School of Medicine Department of Internal Medicine
김혜영 ( Kim Hye-Young ) - Konkuk University School of Medicine Department of Anesthesiology and Pain Medicine
김동운 ( Kim Dong-Woon ) - Chungbuk National University College of Medicine Department of Internal Medicine

Abstract


Background/Aims: Coronary endothelial and microvascular function play important roles in cardiovascular disease. We aimed to evaluate the effect of ticagrelor on coronary artery function and tested the antiplatelet effect of low dose ticagrelor in East-Asian patients.

Methods: Sixty-one consecutive patients with non-significant coronary disease were included in the study. Initially, patients were randomized in 1:1:1 ratio to receive drugs: ticagrelor 90 mg twice a day (bid; n = 22), ticagrelor 45 mg bid (n = 19) or clopidogrel 75 mg once a day (qd; n = 20) and then divided into two groups (ticagrelor vs clopidogrel) for evaluation of coronary artery function, and three groups for evaluation of antiplatelet function. Endothelial dysfunction was measured by coronary flow reserve (CFR), and changes in the levels of asymmetric dimethylarginine (ADMA), cluster of differentiation (CD) 40 ligand, and P-selectin. Microvascular function was evaluated as index of microvascular resistance (IMR). Platelet reactivity was assessed by VerifyNow P2Y12 assay.

Results: The levels of CFR, ADMA, and CD 40 ligand were not different between the two groups. However, P-selectin was lower in the ticagrelor group compared with clopidogrel group. IMR was significantly lower in the ticagrelor group compared with clopidogrel group (median, 15.0 [interquartile range, 12.0 to 21.0] vs. 47.5 [23.0 to 67.5], p = 0.014). There was significant difference in platelet inhibition among the three groups (ticagrelor 90 mg bid vs. ticagrelor 45 mg bid vs. clopidogrel 75 mg qd; 85.57 ± 47.63 vs. 120.33 ± 51.09 vs. 256.42 ± 55.10, p < 0.001)

Conclusions: It is hypothesized that ticagrelor might ameliorate the coronary microvascular function. When compared with clopidogrel, low dose ticagrelor exhibited satisfactory antiplatelet effect in the present study.

키워드

Platelet; Microvessels; Endothelial function

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