Ticagrelor Not Better Than Aspirin for Preventing CV Events.

[Argirios Argiriou]

March 25, 2016

By Amy Orciari Herman

Edited by André Sofair, MD, MPH, and William E. Chavey, MD, MS

The antiplatelet ticagrelor (Brilinta) is no better than aspirin for preventing cardiovascular events in patients with acute ischemic stroke or transient ischemic attack, the manufacturer announced on Wednesday.

In the international SOCRATES trial, adults aged 40 and older who'd had a stroke or TIA within the past 24 hours were randomized to receive ticagrelor (90 mg twice daily) or aspirin (100 mg once daily) for 90 days. The primary efficacy endpoint was the time to first occurrence of stroke (ischemic or hemorrhagic), myocardial infarction, or death.

The manufacturer said that while fewer endpoint events occurred with ticagrelor, the difference between groups was not statistically significant.

Manufacturer's news release:

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[Argirios Argiriou]

November 13, 2016

Ticagrelor No Better Than Clopidogrel in Patients with Symptomatic Peripheral Artery Disease.

Harlan M. Krumholz, MD, SM reviewing Hiatt WR et al. N Engl J Med 2016 Nov 13.

Findings from the EUCLID trial do not support use of the higher-cost platelet inhibitor in this clinical context.

Ticagrelor is a more expensive platelet inhibitor than clopidogrel, prompting ticagrelor's manufacturer to sponsor comparative-effectiveness studies. In the EUCLID trial, 13,885 people (median age, 66; 72% men) with symptomatic peripheral artery disease (PAD) were randomized, in double-blind fashion, to receive ticagrelor (90 mg twice daily) or clopidogrel (75 mg once daily). About three quarters of the participants were taking statins.

During a median follow-up of 30 months, incidence of the primary endpoint — cardiovascular death, myocardial infarction, or ischemic stroke — was statistically similar with ticagrelor and clopidogrel, both overall (10.8% and 10.6%, respectively) and in most prespecified subgroups. Secondary outcomes were also similar with the two drugs, as was the incidence of major bleeding. Discontinuation related to adverse effects was significantly more common with ticagrelor than clopidogrel.

COMMENT

This randomized trial provides no support for ticagrelor over clopidogrel in patients with symptomatic PAD. The findings also raise the broader question of whether ticagrelor should have any role in secondary prevention.

EDITOR DISCLOSURES AT TIME OF PUBLICATION

Disclosures for Harlan M. Krumholz, MD, SM at time of publication
Consultant / Advisory boardUnited Healthcare (Advisory Board); Element Science (Consultant)
EquityImageCor; Hugo PHR
Grant / Research supportAgency for Healthcare Research and Quality; Food and Drug Administration; National Heart, Lung, and Blood Institute; Robert Wood Johnson Foundation; Medtronic; Johnson & Johnson; Chinese National Center for Cardiovascular Disease; Centers for Medicare & Medicaid Services
Editorial boardsBMJ.com/US; American Journal of Managed Care; American Journal of Medicine; Archives of Medical Science; Critical Pathways in Cardiology; Current Cardiovascular Risk Reports; JACC: Cardiovascular Imaging; Circulation: Cardiovascular Quality and Outcomes; Circulation (Associate Editor)
CITATION(S):

Hiatt WR et al. Ticagrelor versus clopidogrel in symptomatic peripheral artery disease. N Engl J Med 2016 Nov 13; [e-pub]. (Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος)

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[Argirios Argiriou]

Ticagrelor May Not Be Superior to Clopidogrel in the Real World

Harlan M. Krumholz, MD, SM reviewing Turgeon RD et al. JAMA Intern Med 2020 Mar

One year after percutaneous coronary intervention, patients taking ticagrelor had similar rates of major cardiovascular events and faced greater safety risks.

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[Argirios Argiriou]

Published:November 14, 2020
The Lancet.

Ticagrelor versus clopidogrel in elective percutaneous coronary intervention (ALPHEUS): a randomised, open-label, phase 3b trial

Interpretation
Ticagrelor was not superior to clopidogrel in reducing periprocedural myocardial necrosis after elective PCI and did not cause an increase in major bleeding, but did increase the rate of minor bleeding at 30 days. These results support the use of clopidogrel as the standard of care for elective PCI.

Σχολιάζει ο συνάδελφος Καρδιολόγος Emmanuel Zachariadis
σε Ιατρική ομάδα του facebook (το ανεβάζω και εδώ μετά από άδειά του):

Πρόσφατη μελέτη (ALPHEUS) έδειξε ότι ο αναστολέας P2Y12 ,TICAGRELOR ( BRILIQUE)  ΔΕΝ υπερέχει συγκριτικά με την κλοπιδογρέλη  στην μείωση επεισοδίων οξέων στεφανιαίων συνδρόμων και επαναστένωσης  μετά από εκλεκτική αγγειοπλαστική στα πλαίσια της στεφανιαίας νόσου.Η αντιμετώπιση των ασθενών με τικαγρελόρη τις πρώτες 30 ημέρες από την αγγειοπλαστική συνδέθηκε με μια ήπια αύξηση αιμορραγικών συμβαμάτων και δύσπνοιας σε σχέση με την κλοπιδογρέλη.


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