Combination of ticagrelor and cilostazol for patients with acute coronary syndrome complicated with upper digestive tract diseases following percutaneous coronary intervention

Abstract

Objective To evaluate the efficacy and safety of combined use of ticagrelor and cilostazol for patients with acute coronary syndrome (ACS) complicated with upper digestive tract diseases following percutaneous coronary intervention (PCI). Methods A total of 262 consecutive ACS patients complicated with upper digestive tract diseases followed-up for one-year after PCI were included in this study. The patients were allocated into control group (combined use of ticagrelor and aspirin, n=184) and cilostazol group (combined use of ticagrelor and cilostazol, n=78) for antiplatelet treatment. The basic characteristics of the patients, change of the treatment regimens, cardiovascular events and hemorrhagic events were compared between two groups. Results After one year of follow-up, 16.8%(31/184)patients in control group and 3.8%(3/78)in cilostazol group changed antiplatelet regimens(χ2=8.200, P=0.004). There was no statistical difference in use of statins and ACEI/ARB between two groups(P>0.05). The rate of proton pump inhibitor use in control group was significantly higher than that in cilostazol group [82.1% (151/184) vs. 52.6%(41/78), χ2=24.35, P=0.000]. However, the dosage of β-blockers in cilostazol group was significantly higher than that in control group [(39.1±12.4)mg vs. (28.6±10.1)mg, t=7.174, P=0.000]. No statistical difference was found in total cardiovascular events between two groups [21.7% (40/184) vs.12.8%(10/78), χ2=2.822, P=0.121]. The incidence of gastrointestinal hemorrhage in control group was significantly increased compared with cilostazol group [12.0%(22/184) vs. 2.6%(2/78), χ2=5.807, P=0.018], however, there was no significant difference in hemorrhagic events concerning the thrombolysis for myocardial infarction between two groups [17.4%(32/184) vs. 9.0%(7/78), χ2=3.063, P=0.089]. Conclusion Combined use of cilostazol and ticagrelor is effective and safe for ACS patients with gastrointestinal hemorrhage or a higher risk of hemorrhage. Key words: Acute coronary syndrome; Platelet aggregation inhibitors; Aspirin; Hemorrhage