Contemporary antiplatelet therapy in acute coronary syndromes: are there differences in outcomes and discontinuation between clopidogrel and ticagrelor?
We studied clinical outcomes and discontinuation rates in a "real world" population presenting with myocardial infarction treated with ticagrelor or clopidogrel.
Between January 2012 and May 2015, 992 patients with acute myocardial infarction undergoing invasive management and adequately pre-treated with dual antiplatelet therapy were prospectively enrolled. Platelet aggregation was measured using the Multiplate analyser. Baseline characteristics, in-hospital outcomes and 1 year outcomes were collected.
Patients treated with ticagrelor were younger and less likely to be diabetic, have a previous myocardial infarction, or present with a STEMI (all P<0.05). Those treated with ticagrelor also had lower CRUSADE (20 ± 9.4 vs. 23 ± 10.1, P<0.0001) and GRACE (119 ± 28 vs. 126 ± 32, P=0.002) scores. High platelet reactivity was greatly reduced with ticagrelor compared to clopidogrel (16.1% vs. 37.0% respectively, p<0.0001). Non-CABG related TIMI major and minor bleeding occurred at similar rates in those treated with ticagrelor and clopidogrel. Rates of drug discontinuation in those treated with ticagrelor and clopidogrel were similar in-hospital (20.2% vs. 16.2%, P=0.18) and between discharge and 1 year (29.9% vs. 27.9%, P=0.63). However, discontinuation due to dyspnoea, (3.3% vs. 0%, P<0.0001) and discontinuation due to any possible drug related adverse event (9.3% vs. 2.2%, P=0.0001) was more common in those treated with ticagrelor compared to clopidogrel CONCLUSION: Ticagrelor is paradoxically being used in lower risk patients rather than those most likely to benefit. Ticagrelor was associated with similar rates of bleeding but higher discontinuation rates due to adverse effects compared to clopidogrel.
Pharmacology, Toxicology and Pharmaceutical Science
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Biochemistry, Genetics and Molecular Biology
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Social Sciences
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Engineering
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Other
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Unknown
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Attention Score in Context
Attention Score in Context
This research output has an Altmetric Attention Score of 1. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 15 November 2017.
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#16,638,094
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#1,739
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#213,369
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Outputs of similar age from Internal Medicine Journal
#23
of 40 outputs
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