Abstract | BACKGROUND: AIM: To compare GIB rates associated with clopidogrel, prasugrel and ticagrelor using national medical and pharmacy claims data from privately insured and Medicare Advantage enrollees . METHODS: Propensity score and inverse probability treatment weighting were used to balance baseline characteristics among treatment groups. The 1-year GIB risk was calculated using weighted Cox proportional hazard models and expressed as hazard ratios (HR) with 95% confidence intervals (CI) and number needed to harm (NNH). RESULTS: We identified 37 019 patients with ACS (non-ST elevation ACS [NSTE-ACS] and ST-elevation myocardial infarction [ STEMI]) within 14 days of a PCI (mean age 63 years and 70% male). Clopidogrel prescription was most common (69%) with prasugrel (16%) and ticagrelor (14%) prescribed less frequently. When compared with clopidogrel, ticagrelor was associated with a 34% risk reduction (HR 0.66; 95% CI: 0.54-0.81) in GIB overall and with NSTE-ACS, and a 37% GIB risk reduction (HR 0.63; 95% CI: 0.42-0.93) in STEMI patients. When compared with clopidogrel, prasugrel was associated with a 21% risk reduction (HR 0.79; 95% CI: 0.64-0.97) overall, a 36% GIB risk reduction (HR 0.64; 95% CI: 0.49-0.85) in STEMI patients but no reduction of GIB risk in NSTE-ACS patients. CONCLUSIONS:
|
Authors | Neena S Abraham, Eric H Yang, Peter A Noseworthy, Jonathan Inselman, Xiaoxi Yao, Jeph Herrin, Lindsey R Sangaralingham, Che Ngufor, Nilay D Shah |
Journal | Alimentary pharmacology & therapeutics
(Aliment Pharmacol Ther)
Vol. 52
Issue 4
Pg. 646-654
(08 2020)
ISSN: 1365-2036 [Electronic] England |
PMID | 32657466
(Publication Type: Journal Article, Research Support, U.S. Gov't, P.H.S.)
|
Copyright | © 2020 John Wiley & Sons Ltd. |
Chemical References |
- Platelet Aggregation Inhibitors
- Clopidogrel
- Prasugrel Hydrochloride
- Ticagrelor
|
Topics |
- Acute Coronary Syndrome
(drug therapy, epidemiology, surgery)
- Aged
- Clopidogrel
(adverse effects, therapeutic use)
- Cohort Studies
- Female
- Gastrointestinal Hemorrhage
(chemically induced, epidemiology)
- Humans
- Male
- Middle Aged
- Percutaneous Coronary Intervention
(adverse effects, methods)
- Platelet Aggregation Inhibitors
(adverse effects)
- Postoperative Complications
(chemically induced, epidemiology, prevention & control)
- Prasugrel Hydrochloride
(adverse effects, therapeutic use)
- Retrospective Studies
- Thromboembolism
(epidemiology, prevention & control)
- Ticagrelor
(adverse effects, therapeutic use)
- Treatment Outcome
- United States
(epidemiology)
|