In-hospital outcomes of Ticagrelor versus Clopidogrel in high bleeding risk patients with acute coronary syndrome: Findings from the CCC-ACS project.

Abstract

BACKGROUND:

The optimal P2Y12 inhibitor in high bleeding risk (HBR) patients with acute coronary syndrome (ACS) remains unclear. We compared the in-hospital efficacy and safety of ticagrelor versus clopidogrel in ACS patients at HBR.

METHODS:

We identified 22,120 hospitalized ACS patients with HBR treated with aspirin combined with either clopidogrel (n = 17,420) or ticagrelor (n = 4700) in the Improving Care for Cardiovascular Disease in China-ACS (CCC-ACS) project between November 2014 and December 2019.

RESULTS:

The median length of hospital stay was 10 days (interquartile range, 7-14 days). Compared with clopidogrel, ticagrelor was associated with a higher risk of in-hospital TIMI major or minor bleeding (4.8% vs 3.8%; adjusted OR 1.20; 95% CI 1.03-1.41; P = 0.022). The incidence of TIMI major bleeding (1.7% vs 1.1%, P = 0.005) and intracranial bleeding (0.8% vs 0.5%, P = 0.005) were also higher in the ticagrelor group than in the clopidogrel group. There was no significant difference in the rate of in-hospital major adverse cardiovascular and cerebrovascular event (MACCE) (a composite of all-cause death, myocardial infarction, stent thrombosis, or ischemic stroke) with ticagrelor compared with clopidogrel therapy (4.2% vs 4.3%; adjusted OR 1.08; 95% CI 0.90-1.28; P = 0.411). Outcomes in the propensity-matched cohorts and in sensitivity analyses were consistent with the those of the main analysis.

CONCLUSIONS:

Among ACS patients with HBR, ticagrelor as compared with clopidogrel was associated with an increased risk of in-hospital major bleeding without a significant reduction in in-hospital MACCE.

CLINICAL TRIAL REGISTRATION:

https://www.

CLINICALTRIALS:

gov. Unique identifier: NCT02306616.

• Authors: Yue Wang, Na Yang, Min Suo, Xinyan Liu, Zhiqiang Wang, Xiaojiang Zhang, Jing Liu, Dong Zhao, Xiaofan Wu, CCC-ACS Investigators
• Journal: Thrombosis research (Thromb Res) Vol. 216 Pg. 43-51 (08 2022) ISSN: 1879-2472 [Electronic] United States
• PMID: 35714445 (Publication Type: Clinical Trial, Comparative Study, Journal Article)
• Copyright: Copyright © 2022. Published by Elsevier Ltd.

Chemical References

• Platelet Aggregation Inhibitors
• Clopidogrel
• Ticagrelor

Topics

• Acute Coronary Syndrome (complications, drug therapy)
• Clopidogrel (adverse effects)
• Hemorrhage (etiology)
• Hospitals
• Humans
• Percutaneous Coronary Intervention (adverse effects)
• Platelet Aggregation Inhibitors (adverse effects)
• Ticagrelor (adverse effects)
• Treatment Outcome