Comparison of ticagrelor with clopidogrel in patients with a planned invasive strategy for acute coronary syndromes (PLATO): a randomised double-blind study

Cannon, Christopher P.; Harrington, Robert A.; James, Stefan; Ardissino, Diego; Becker, Richard C.; Emanuelsson, Håkan; Husted, Steen; Katus, Hugo A.; Keltai, Mátyás; Khurmi, Nardev S.; Kontny, Frederic; Lewis, Basil S.; Steg, Philippe Gabriel; Storey, Robert F.; Wojdyla, Daniel; Wallentin, Lars

doi:10.1016/s0140-6736(09)62191-7

Cited by 604 publications

(374 citation statements)

References 33 publications

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“…The data from randomized clinical trials confirmed that stronger platelet inhibition in acute coronary syndrome patients treated with PCI reduces the rate of ischemic events, with an increase in risk of bleeding complications [29][30][31][32]. However, such an association has been less apparent in patients with stable angina [33].…”

Section: Discussionmentioning

confidence: 99%

Optimal aNtiplatelet pharmacotherapy guided by bedSIDE genetic or functional TESTing in elective PCI patients: A pilot study: ONSIDE TEST pilot

et al. 2017

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Section: Discussionmentioning

confidence: 99%

Optimal aNtiplatelet pharmacotherapy guided by bedSIDE genetic or functional TESTing in elective PCI patients: A pilot study: ONSIDE TEST pilot

et al. 2017

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“…All 3 arms in RE‐DUAL PCI will allow the use of ticagrelor, given the benefits seen in reducing risk of death and the lack of increase in major bleeding, when analyzed in intent‐to‐treat, compared with clopidogrel in the Platelet Inhibition and Platelet Outcomes (PLATO) trial 39. It should also be noted that there are sparse data on the use of ticagrelor in nonvalvular AF patients who have undergone PCI.…”

Section: Discussionmentioning

confidence: 99%

Design and Rationale of the RE‐DUAL PCI Trial: A Prospective, Randomized, Phase 3b Study Comparing the Safety and Efficacy of Dual Antithrombotic Therapy With Dabigatran Etexilate Versus Warfarin Triple Therapy in Patients With Nonvalvular Atrial Fibrillation Who Have Undergone Percutaneous Coronary Intervention With Stenting

Cannon

Gropper

Bhatt

et al. 2016

Clinical Cardiology

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Antithrombotic management of patients with atrial fibrillation (AF) undergoing coronary stenting is complicated by the need for anticoagulant therapy for stroke prevention and dual antiplatelet therapy for prevention of stent thrombosis and coronary events. Triple antithrombotic therapy, typically comprising warfarin, aspirin, and clopidogrel, is associated with a high risk of bleeding. A modest‐sized trial of oral anticoagulation with warfarin and clopidogrel without aspirin showed improvements in both bleeding and thrombotic events compared with triple therapy, but large trials are lacking. The RE‐DUAL PCI trial (NCT 02164864) is a phase 3b, a strategy of prospective, randomized, open‐label, blinded‐endpoint trial. The main objective is to evaluate dual antithrombotic therapy with dabigatran etexilate (110 or 150 mg twice daily) and a P2Y12 inhibtor (either clopidogrel or ticagrelor) compared with triple antithrombotic therapy with warfarin, a P2Y12 inhibtor (either clopidogrel or ticagrelor, and low‐dose aspirin (for 1 or 3 months, depending on stent type) in nonvalvular AF patients who have undergone percutaneous coronary intervention with stenting. The primary endpoint is time to first International Society of Thrombosis and Hemostasis major bleeding event or clinically relevant nonmajor bleeding event. Secondary endpoints are the composite of all cause death or thrombotic events (myocardial infarction, or stroke/systemic embolism) and unplanned revascularization; death or thrombotic events; individual outcome events; death, myocardial infarction, or stroke; and unplanned revascularization. A hierarchical procedure for multiple testing will be used. The plan is to randomize ∼ 2500 patients at approximately 550 centers worldwide to try to identify new treatment strategies for this patient population.

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“…However, the inherent limitations of clopidogrel are well recognised, including a slow onset of action and a variable response [10][11][12][13] . Prasugrel and ticagrelor provide superior protection against ischaemic adverse events compared with clopidogrel in patients following an ACS undergoing percutaneous coronary intervention (PCI) [14][15][16] . Notwithstanding this, both drugs incur an increased risk of spontaneous bleeding.…”

Section: Introductionmentioning

confidence: 99%

Long-term ticagrelor monotherapy versus standard dual antiplatelet therapy followed by aspirin monotherapy in patients undergoing biolimus-eluting stent implantation: rationale and design of the GLOBAL LEADERS trial

Vranckx¹,

Valgimigli²,

Windecker³

et al. 2016

EuroIntervention

115

123

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Aims: The GLOBAL LEADERS trial is a superiority study in patients undergoing percutaneous coronary intervention, with a uniform use of Biolimus A9-eluting stents (BES) and bivalirudin. GLOBAL LEADERS was designed to assess whether a 24-month antithrombotic regimen with ticagrelor and one month of acetylsalicylic acid (ASA), compared to conventional dual antiplatelet therapy (DAPT), improves outcomes.Methods and results: Patients (n >16,000) are randomised (1:1 ratio) to ticagrelor 90 mg twice daily for 24 months plus ASA ≤100 mg for one month versus DAPT with either ticagrelor (acute coronary syndrome) or clopidogrel (stable coronary artery disease) for 12 months plus ASA ≤100 mg for 24 months. The primary outcome is a composite of all-cause mortality or non-fatal, new Q-wave myocardial infarction at 24 months. The key safety endpoint is investigator-reported class 3 or 5 bleeding according to the Bleeding Academic Research Consortium (BARC) definitions. Sensitivity analysis will be carried out to explore potential differences in outcome across geographic regions and according to specific angiographic and clinical risk estimates. Conclusions:The GLOBAL LEADERS trial aims to assess the role of ticagrelor as a single antiplatelet agent after a short course of DAPT for the long-term prevention of cardiac adverse events, across a wide spectrum of patients, following BES implantation. KEYWORDS

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Comparison of ticagrelor with clopidogrel in patients with a planned invasive strategy for acute coronary syndromes (PLATO): a randomised double-blind study

Cited by 604 publications

References 33 publications

Optimal aNtiplatelet pharmacotherapy guided by bedSIDE genetic or functional TESTing in elective PCI patients: A pilot study: ONSIDE TEST pilot

Optimal aNtiplatelet pharmacotherapy guided by bedSIDE genetic or functional TESTing in elective PCI patients: A pilot study: ONSIDE TEST pilot

Long-term ticagrelor monotherapy versus standard dual antiplatelet therapy followed by aspirin monotherapy in patients undergoing biolimus-eluting stent implantation: rationale and design of the GLOBAL LEADERS trial

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