If this is not your name, click here.
| | If this is not your name, click here. | | |
| | Contact Us | Order Now | Journals | Bookstore | Register a colleague | | |
| |  Ticagrelor Superior to Clopidogrel for Management of Patients With ACS Undergoing PCI NEW YORK -- January 13, 2010 -- New research shows that ticagrelor reduces death rates without increasing bleeding compared with the current standard treatment of clopidogrel for patients with myocardial infarction (MI). The new analysis of the Platelet Inhibition and Patient Outcomes (PLATO) trial is published online first and will appear in an upcoming edition of The Lancet. “… using a stronger anticlotting drug lowered the chance of having a second myocardial infarction and reduced the risk of dying from one,” said lead author Christopher P Cannon, MD, Cardiovascular Division, Brigham and Women’s Hospital, Boston, Massachusetts. “This is a key advance for [patients with myocardial infarction].” For the study, Dr. Cannon and colleagues compared ticagrelor with clopidogrel in patients with acute coronary syndromes who were planning to undergo invasive percutaneous coronary intervention (PCI) procedures. At the beginning of the study, an invasive strategy was planned for 13,408 (72.0%) of 18,624 patients hospitalised for acute coronary syndromes. Patients were randomly assigned in a 1:1 ratio to ticagrelor 180 mg loading dose followed by 90 mg twice a day plus placebo or to clopidogrel 300 to 600 mg loading dose or continuation with maintenance dose followed by 75 mg per day plus placebo for 6 to 12 months. All patients were given aspirin. The primary endpoint was any of cardiovascular death, MI, or stroke. Patients in the ticagrelor group were 16% less likely to experience the primary endpoint than those in the clopidogrel group. The endpoint of cardiovascular death, MI or stroke occurred in fewer patients in the ticagrelor group than in the clopidogrel group (event rate at 360 days 9.0% vs 10.7%). The risk of death was also significantly reduced from 5.0% (clopidogrel) to 3.9% (ticagrelor), a reduction in the risk of dying over 1 year of around one fifth. Blood clots developing inside heart stents were also significantly reduced. There was no statistically significant difference between groups in the rates of total major bleeding (12% each group), or severe bleeding (3% both groups). “Patients given ticagrelor had significant and clinically relevant reductions in cardiovascular and total deaths, myocardial infarction, and stent thrombosis, without an increase in risk of major bleeding,” the authors wrote. “The benefits with respect to clinical events and stent thrombosis were consistent whether or not patients were given standard or higher loading doses of clopidogrel, as advocated for patients undergoing invasive strategies. Thereby, ticagrelor has important advantages, and improves the early invasive and long-term management of patients with acute coronary syndromes.” “We estimate that use of ticagrelor instead of clopidogrel for 1 year in 1000 patients with acute coronary syndromes and who are planned to undergo an invasive strategy at the start of drug treatment would lead to 11 fewer deaths, 13 fewer myocardial infarctions, and 6 fewer cases of stent thrombosis without an increase in the rates of major bleeding or transfusion,” the authors concluded. In an accompanying comment, Gregg W Stone, MD, Columbia University Medical Center, New York, New York, said: “These compelling results support ticagrelor as a new standard of care in acute coronary syndromes. However, a personalised approach to drug selection should be used wherein each patient’s individualised risk of ischaemia versus bleeding is considered. Clopidogrel might still be appropriate for selected patients who are at relatively low risk of myocardial infarction or stent thrombosis and/or high risk of major bleeding, and/or for whom non-compliance with ticagrelor because of cost or other considerations is a concern. Nonetheless, the introduction of ticagrelor, a more potent and effective agent which is as safe as its predecessor, is a landmark event that should redefine the care of patients with acute coronary syndromes.”
SOURCE: The Lancet
|
