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Ticagrelor versus clopidogrel in patients with ST-elevation acute coronary syndromes intended for reperfusion with primary percutaneous coronary intervention: A Platelet Inhibition and Patient Outcomes (PLATO) trial subgroup analysis.

AbstractBACKGROUND:
Aspirin and clopidogrel are recommended for patients with acute coronary syndromes (ACS) or undergoing coronary stenting. Ticagrelor, a reversible oral P2Y12-receptor antagonist, provides faster, greater, and more consistent platelet inhibition than clopidogrel and may be useful for patients with acute ST-segment elevation (STE) ACS and planned primary percutaneous coronary intervention.
METHODS AND RESULT:
Platelet Inhibition and Patient Outcomes (PLATO), a randomized, double-blind trial, compared ticagrelor with clopidogrel for the prevention of vascular events in 18 624 ACS patients. This report concerns the 7544 ACS patients with STE or left bundle-branch block allocated to either ticagrelor 180-mg loading dose followed by 90 mg twice daily or clopidogrel 300-mg loading dose (with provision for 300 mg clopidogrel at percutaneous coronary intervention) followed by 75 mg daily for 6 to 12 months. The reduction of the primary end point (myocardial infarction, stroke, or cardiovascular death) with ticagrelor versus clopidogrel (10.8% versus 9.4%; hazard ratio [HR], 0.87; 95% confidence interval, 0.75 to 1.01; P=0.07) was consistent with the overall PLATO results. There was no interaction between presentation with STE/left bundle-branch block and randomized treatment (interaction P=0.29). Ticagrelor reduced several secondary end points, including myocardial infarction alone (HR, 0.80; P=0.03), total mortality (HR, 0.82; P=0.05), and definite stent thrombosis (HR, 0.66; P=0.03). The risk of stroke, low in both groups, was higher with ticagrelor (1.7% versus 1.0%; HR,1.63; 95% confidence interval, 1.07 to 2.48; P=0.02). Ticagrelor did not affect major bleeding (HR, 0.98; P=0.76).
CONCLUSION:
In patients with STE-ACS and planned primary percutaneous coronary intervention, the effects of ticagrelor were consistent with those observed in the overall PLATO trial.
CLINICAL TRIAL REGISTRATION:
URL: http://www.ClinicalTrials.gov. Unique identifier: NCT00391872.
AuthorsPhilippe Gabriel Steg, Stefan James, Robert A Harrington, Diego Ardissino, Richard C Becker, Christopher P Cannon, Håkan Emanuelsson, Ariel Finkelstein, Steen Husted, Hugo Katus, Jan Kilhamn, Sylvia Olofsson, Robert F Storey, W Douglas Weaver, Lars Wallentin,
JournalCirculation (Circulation) Vol. 122 Issue 21 Pg. 2131-41 (Nov 23 2010) ISSN: 1524-4539 [Electronic] United States
PMID21060072 (Publication Type: Comparative Study, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
Chemical References
  • Platelet Aggregation Inhibitors
  • Purinergic P2Y Receptor Antagonists
  • clopidogrel
  • Ticagrelor
  • Adenosine
  • Ticlopidine
Topics
  • Acute Coronary Syndrome (diagnosis, drug therapy, epidemiology)
  • Adenosine (administration & dosage, adverse effects, analogs & derivatives)
  • Aged
  • Angioplasty, Balloon, Coronary
  • Coronary Thrombosis (epidemiology, prevention & control)
  • Electrocardiography
  • Female
  • Hemorrhage (chemically induced, epidemiology)
  • Humans
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Platelet Aggregation Inhibitors (administration & dosage, adverse effects)
  • Purinergic P2Y Receptor Antagonists (administration & dosage, adverse effects)
  • Risk Factors
  • Ticlopidine (administration & dosage, adverse effects, analogs & derivatives)
  • Treatment Outcome

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