Efficacy and safety of different ticagrelor regimens versus clopidogrel in patients with coronary artery disease: a retrospective multicenter study (SUPERIOR)

He, Meijiao; Wang, Wennan; Liu, Guangzhong; Zhang, Haiyu; Sun, Danghui; Li, Jianqiang; Mu, Hongyuan; Xu, Minglu; Zhao, Chenyang; Wang, Jiayu; Zhang, Chongyang; Cang, Hai; Zhao, Shuai; Zhang, Zhiren; Li, Yue

doi:10.1080/09537104.2020.1732328

Cited by 7 publications

(4 citation statements)

References 30 publications

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“…[17][18][19] Subsequently, an observational study of Chinese ACS patients suggested that DAPT with aspirin and ticagrelor 45 mg BID or ticagrelor 90 mg QD may provide similar platelet inhibition to ticagrelor 90 mg BID but with a reduced risk of bleeding. 16 Notwithstanding these important prior observations, the current analysis supports the use of ticagrelor monotherapy at a 90-mg BID regimen after 3 months of DAPT in high-risk Chinese patients with no increased risk of adverse bleeding or ischemic events as compared with non-Chinese patients on the same treatment regimen. The recently published TWILIGHT platelet substudy provides a mechanistic foundation for these findings, showing that the antithrombotic potency of ticagrelor monotherapy is similar to that of ticagrelor plus aspirin in an ex vivo model to quantify thrombus size under dynamic flow conditions.…”

Section: Discussionsupporting

confidence: 61%

“…Before the current analysis, data on the use of ticagrelor in a Chinese population were scarce. 15,16 Indeed, TWILIGHT China provides the first data on the use of ticagrelor monotherapy in a Chinese population. Several previous studies have questioned the one-size-fits-all approach of a 90-mg BID ticagrelor regimen in Chinese patients, although it should be kept in mind that all previous studies were performed in the context of DAPT with ticagrelor and aspirin.…”

Section: Discussionmentioning

confidence: 99%

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Ticagrelor With or Without Aspirin in Chinese Patients Undergoing Percutaneous Coronary Intervention: A TWILIGHT China Substudy

Han

Claessen

Chen³

et al. 2022

Circ: Cardiovascular Interventions

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Background: The risk/benefit tradeoff of dual antiplatelet therapy after percutaneous coronary intervention may vary in East Asian patients as compared with their non-East Asian counterparts. Methods: The double-blind, placebo-controlled, randomized TWILIGHT trial (Ticagrelor With Aspirin or Alone in High-Risk Patients After Coronary Intervention) enrolled patients undergoing high-risk percutaneous coronary intervention. After 3 months of treatment with ticagrelor plus aspirin, event-free and adherent patients remained on ticagrelor and were randomly assigned to receive aspirin or placebo for 1 year. The primary end point was Bleeding Academic Research Consortium type 2, 3, or 5 bleeding; the key secondary end point was the first occurrence of death from any cause, nonfatal myocardial infarction, or nonfatal stroke. Results: Of 9006 enrolled and 7119 randomized patients in TWILIGHT, 1169 patients (13.0%) were enrolled at 27 Chinese sites in this prespecified substudy, of whom 1028 (14.4%) patients were randomized after 3 months. The incidence of the primary end point was 6.2% in the ticagrelor+aspirin group versus 3.5% in the ticagrelor+placebo group between randomization and 1 year (hazard ratio, 0.56 [95% CI, 0.31–0.99]; P =0.048). The key secondary end point occurred in 3.4% of patients in the ticagrelor+aspirin group versus 2.4% in the ticagrelor+placebo group (hazard ratio, 0.70 [95% CI, 0.33–1.46]; P =0.34). There was no interaction between the region of randomization (China versus the rest of the world) and randomized treatment assignment in terms of the primary or key secondary end points. Conclusions: Ticagrelor monotherapy significantly reduced clinically relevant bleeding without increasing ischemic events as compared with ticagrelor plus aspirin in Chinese patients undergoing high-risk percutaneous coronary intervention. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02270242.

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Section: Discussionsupporting

confidence: 61%

Section: Discussionmentioning

confidence: 99%

Ticagrelor With or Without Aspirin in Chinese Patients Undergoing Percutaneous Coronary Intervention: A TWILIGHT China Substudy

Han

Claessen

Chen³

et al. 2022

Circ: Cardiovascular Interventions

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“…Ticagrelor is approved for patients in Japan when other P2Y 12 inhibitors are unsuitable. Furthermore, a study done in China showed that, in a special population with a high risk of bleeding, ticagrelor with a dose <90 mg prescribed twice daily may have a better benefit-to-risk ratio, and there is a need for further evidence to support these findings [27] .…”

Section: Discussionmentioning

confidence: 99%

Safety and Efficacy of Ticagrelor versus Clopidogrel in East Asian Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention Treated with Dual Antiplatelet Therapy: A Meta-Analysis of Randomized Controlled Trials

Li¹,

Wang²,

Wu³

et al. 2023

Cardiology

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Introduction: The treatment strategy for dual antiplatelet therapy (DAPT) with ticagrelor has been controversial in East Asian patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). Our meta-analysis aimed to demonstrate whether intensified antithrombotic regimens with ticagrelor plus aspirin have more beneficial effects and fewer adverse events compared to those of clopidogrel plus aspirin in East Asian patients with ACS undergoing PCI. Methods: We searched PubMed, Embase, Web of Science, Science Direct, Clinical Trial, Cochrane Library, and Chinese Clinical Trial Registry for randomized controlled trials (RCTs) comparing the efficacy of DAPT with ticagrelor or clopidogrel plus aspirin for secondary prevention of ACS in East Asian patients undergoing PCI. Risk ratios (RR) and 95% confidence intervals (CIs) were used as the metrics of choice for assessing treatment effect. The primary endpoint was bleeding events, and the secondary endpoints were major adverse cardiovascular and cerebrovascular events (MACCE, including cardiovascular death, non-fatal myocardial infarction, and stroke), all-cause death, and definite/probable/possible stent thrombosis. The I² index was used to assess heterogeneity. Results: Six RCTs involving a total of 2,725 patients met the inclusion criteria. The incidence of all bleeding events with ticagrelor was higher than that with clopidogrel (RR, 1.65; 95%CI, 1.31–2.07), but the incidence of MACCE was not significantly different between the two groups (RR, 1.08; 95%CI, 0.54–2.16). All-cause death (RR, 1.10; 95%CI, 0.67–1.79), cardiovascular death (RR, 1.42; 95%CI, 0.68–2.98), non-fatal MI (RR, 0.92; 95%CI, 0.48–1.78), stroke (RR,1.00; 95%CI, 0.40–2.50), and stent thrombosis (RR, 0.76; 95%CI, 0.19-2.98) were not statistically different between the two groups. Conclusion: Ticagrelor increased the risk of bleeding and did not increase treatment efficacy compared to that of clopidogrel in the East Asian population who have ACS treated with PCI.

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“…In our previous study, we found that low-dose of ticagrelor elicited a greater platelet inhibitory effect than clopidogrel in Chinese patients with coronary artery disease (CAD) [31][32][33][34] . In the PEGASUS-TIMI 54 trial [35] , ticagrelor at either 60 mg or 90 mg twice daily reduced the risk of cardiovascular death, myocardial infarction, or stroke in patients with myocardial infarction.…”

Section: Discussionmentioning

confidence: 99%

Ticagrelor versus clopidogrel in East Asian patients with acute coronary syndrome: A meta-analysis

Zang

Sun

et al. 2022

Frigid Zone Medicine

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Objective There exist conflicting data on the efficacy and safety of ticagrelor and clopidogrel in East Asian patients with acute coronary syndrome (ACS). We performed a meta-analysis to evaluate whether ticagrelor or clopidogrel produces better outcomes for East Asian patients with ACS. Methods We searched for randomized controlled trials reporting associations between ticagrelor and clopidogrel in East Asian patients with acute coronary syndrome in PubMed, EMBASE, web of science and Cochrane central register of controlled trials. Results Ten studies involving 3 715 participants were qualified for our analysis. The major adverse cardiovascular events (MACE) were significantly decreased in patients with ticagrelor treatment compared to those with clopidogrel (risk ratio [RR]: 0.61; 95% confidence interval [CI]: 0.38–0.98; P = 0.042). There was no significant difference in all-cause death (RR: 0.89; 95% CI: 0.61–1.29; P = 0.540), cardiovascular death (RR: 0.86; 95% CI: 0.58–1.27; P = 0.451), myocardial infarction (RR: 0.91; 95% CI: 0.65–1.27; P = 0.575) and stroke (RR: 0.77; 95% CI: 0.44–1.36; P = 0.372) between ticagrelor and clopidogrel. Ticagrelor was associated with a significantly higher risk of bleeding compared to clopidogrel (RR: 1.71; 95% CI: 1.37–2.13; P = 0.000). Conclusion The present meta-analysis demonstrates that ticagrelor reduced the incidence of MACE in ACS patients from East Asia compared with clopidogrel. However, it increased the risk of bleeding.

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Efficacy and safety of different ticagrelor regimens versus clopidogrel in patients with coronary artery disease: a retrospective multicenter study (SUPERIOR)

Cited by 7 publications

References 30 publications

Ticagrelor With or Without Aspirin in Chinese Patients Undergoing Percutaneous Coronary Intervention: A TWILIGHT China Substudy

Ticagrelor With or Without Aspirin in Chinese Patients Undergoing Percutaneous Coronary Intervention: A TWILIGHT China Substudy

Safety and Efficacy of Ticagrelor versus Clopidogrel in East Asian Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention Treated with Dual Antiplatelet Therapy: A Meta-Analysis of Randomized Controlled Trials

Ticagrelor versus clopidogrel in East Asian patients with acute coronary syndrome: A meta-analysis

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