Ticagrelor versus clopidogrel in patients with acute coronary syndromes
- PMID: 19717846
- DOI: 10.1056/NEJMoa0904327
Ticagrelor versus clopidogrel in patients with acute coronary syndromes
Abstract
Background: Ticagrelor is an oral, reversible, direct-acting inhibitor of the adenosine diphosphate receptor P2Y12 that has a more rapid onset and more pronounced platelet inhibition than clopidogrel.
Methods: In this multicenter, double-blind, randomized trial, we compared ticagrelor (180-mg loading dose, 90 mg twice daily thereafter) and clopidogrel (300-to-600-mg loading dose, 75 mg daily thereafter) for the prevention of cardiovascular events in 18,624 patients admitted to the hospital with an acute coronary syndrome, with or without ST-segment elevation.
Results: At 12 months, the primary end point--a composite of death from vascular causes, myocardial infarction, or stroke--had occurred in 9.8% of patients receiving ticagrelor as compared with 11.7% of those receiving clopidogrel (hazard ratio, 0.84; 95% confidence interval [CI], 0.77 to 0.92; P<0.001). Predefined hierarchical testing of secondary end points showed significant differences in the rates of other composite end points, as well as myocardial infarction alone (5.8% in the ticagrelor group vs. 6.9% in the clopidogrel group, P=0.005) and death from vascular causes (4.0% vs. 5.1%, P=0.001) but not stroke alone (1.5% vs. 1.3%, P=0.22). The rate of death from any cause was also reduced with ticagrelor (4.5%, vs. 5.9% with clopidogrel; P<0.001). No significant difference in the rates of major bleeding was found between the ticagrelor and clopidogrel groups (11.6% and 11.2%, respectively; P=0.43), but ticagrelor was associated with a higher rate of major bleeding not related to coronary-artery bypass grafting (4.5% vs. 3.8%, P=0.03), including more instances of fatal intracranial bleeding and fewer of fatal bleeding of other types.
Conclusions: In patients who have an acute coronary syndrome with or without ST-segment elevation, treatment with ticagrelor as compared with clopidogrel significantly reduced the rate of death from vascular causes, myocardial infarction, or stroke without an increase in the rate of overall major bleeding but with an increase in the rate of non-procedure-related bleeding. (ClinicalTrials.gov number, NCT00391872.)
2009 Massachusetts Medical Society
Comment in
-
Ticagrelor--is there need for a new player in the antiplatelet-therapy field?N Engl J Med. 2009 Sep 10;361(11):1108-11. doi: 10.1056/NEJMe0906549. Epub 2009 Aug 30. N Engl J Med. 2009. PMID: 19717845 No abstract available.
-
Ticagrelor versus clopidogrel in acute coronary syndromes.N Engl J Med. 2009 Dec 10;361(24):2385; author reply 2387-8. doi: 10.1056/NEJMc0909586. N Engl J Med. 2009. PMID: 20007565 No abstract available.
-
ACP Journal Club. Ticagrelor was more effective than clopidogrel, with no increase in major bleeding in acute coronary syndromes.Ann Intern Med. 2009 Dec 15;151(12):JC6-4. doi: 10.7326/0003-4819-151-12-200912150-02004. Ann Intern Med. 2009. PMID: 20008753 No abstract available.
-
Ticagrelor versus clopidogrel in acute coronary syndromes.N Engl J Med. 2009 Dec 10;361(24):2385-6; author reply 2387-8. N Engl J Med. 2009. PMID: 20050196 No abstract available.
-
Ticagrelor versus clopidogrel in acute coronary syndromes.N Engl J Med. 2009 Dec 10;361(24):2386; author reply 2387-8. N Engl J Med. 2009. PMID: 20050197 No abstract available.
-
Ticagrelor versus clopidogrel in acute coronary syndromes.N Engl J Med. 2009 Dec 10;361(24):2386-7; author reply 2387-8. N Engl J Med. 2009. PMID: 20050198 No abstract available.
-
New drugs for the treatment of coronary artery syndromes: otamixaban and ticagrelor.Expert Opin Pharmacother. 2010 Feb;11(2):325-9. doi: 10.1517/14656560903473173. Expert Opin Pharmacother. 2010. PMID: 20088750 No abstract available.
-
PLATO study of ticagrelor versus clopidogrel in patients with high-risk acute coronary syndromes.Curr Cardiol Rep. 2010 Jul;12(4):283-5. doi: 10.1007/s11886-010-0114-9. Curr Cardiol Rep. 2010. PMID: 20432073 No abstract available.
-
News and views from the literature. Antiplatelet therapy. Ticagrelor in acute coronary syndrome: a new frontier in platelet inhibition.Rev Cardiovasc Med. 2010 Spring;11(2):117-20. doi: 10.3909/ricm0539. Rev Cardiovasc Med. 2010. PMID: 20700096 No abstract available.
-
Exploring PLATO-USA paradox and CURRENT-OASIS 7 trials reveals the benefit of higher aspirin dose.Am J Ther. 2015 Jan-Feb;22(1):85-6. doi: 10.1097/MJT.0b013e31825e7aab. Am J Ther. 2015. PMID: 23728159 No abstract available.
-
The evolution of dual antiplatelet therapy in the setting of acute coronary syndrome: ticagrelor versus clopidogrel.Postgrad Med. 2016;128(2):159-63. doi: 10.1080/00325481.2016.1118351. Epub 2015 Dec 10. Postgrad Med. 2016. PMID: 26560350
Similar articles
-
Ticagrelor Versus Clopidogrel in Patients With Acute Coronary Syndromes and Chronic Obstructive Pulmonary Disease: An Analysis From the Platelet Inhibition and Patient Outcomes (PLATO) Trial.J Am Heart Assoc. 2015 Oct 9;4(10):e002490. doi: 10.1161/JAHA.115.002490. J Am Heart Assoc. 2015. PMID: 26452988 Free PMC article. Clinical Trial.
-
Comparison of ticagrelor with clopidogrel in patients with a planned invasive strategy for acute coronary syndromes (PLATO): a randomised double-blind study.Lancet. 2010 Jan 23;375(9711):283-93. doi: 10.1016/S0140-6736(09)62191-7. Epub 2010 Jan 13. Lancet. 2010. PMID: 20079528 Clinical Trial.
-
Clinically significant bleeding with low-dose rivaroxaban versus aspirin, in addition to P2Y12 inhibition, in acute coronary syndromes (GEMINI-ACS-1): a double-blind, multicentre, randomised trial.Lancet. 2017 May 6;389(10081):1799-1808. doi: 10.1016/S0140-6736(17)30751-1. Epub 2017 Mar 18. Lancet. 2017. PMID: 28325638 Clinical Trial.
-
Ticagrelor--a new platelet aggregation inhibitor in patients with acute coronary syndromes. An improvement of other inhibitors?Med Sci Monit. 2009 Dec;15(12):MS24-30. Med Sci Monit. 2009. PMID: 19946242 Review.
-
Ticagrelor: an investigational oral antiplatelet treatment for reduction of major adverse cardiac events in patients with acute coronary syndrome.Vasc Health Risk Manag. 2010 Oct 21;6:963-77. doi: 10.2147/VHRM.S13263. Vasc Health Risk Manag. 2010. PMID: 21057581 Free PMC article. Review.
Cited by
-
Treatment and Care of Patients with ST-Segment Elevation Myocardial Infarction-What Challenges Remain after Three Decades of Primary Percutaneous Coronary Intervention?J Clin Med. 2024 May 15;13(10):2923. doi: 10.3390/jcm13102923. J Clin Med. 2024. PMID: 38792463 Free PMC article. Review.
-
Italian Association of Hospital Cardiologists Position Paper 'Gender discrepancy: time to implement gender-based clinical management'.Eur Heart J Suppl. 2024 May 16;26(Suppl 2):ii264-ii293. doi: 10.1093/eurheartjsupp/suae034. eCollection 2024 Apr. Eur Heart J Suppl. 2024. PMID: 38784671 Free PMC article.
-
Contemporary Prestroke Dual Antiplatelet Use and Symptomatic Intracerebral Hemorrhage Risk After Thrombolysis.JAMA Neurol. 2024 Jul 1;81(7):722-731. doi: 10.1001/jamaneurol.2024.1312. JAMA Neurol. 2024. PMID: 38767894
-
Incidence and pattern of urgent revascularization in acute coronary syndromes treated with ticagrelor or prasugrel.Clin Res Cardiol. 2024 Jul;113(7):1060-1069. doi: 10.1007/s00392-024-02454-x. Epub 2024 May 13. Clin Res Cardiol. 2024. PMID: 38740722 Free PMC article. Clinical Trial.
-
Discharge of Acute Coronary Syndrome Patients on Sub-Optimal Dual Anti-Platelet Therapy: A Single Center Experience.Cardiovasc Drugs Ther. 2024 May 10. doi: 10.1007/s10557-024-07563-3. Online ahead of print. Cardiovasc Drugs Ther. 2024. PMID: 38727897
Publication types
MeSH terms
Substances
Associated data
LinkOut - more resources
Full Text Sources
Other Literature Sources
Medical