Ticagrelor versus clopidogrel in Asian patients with acute coronary syndrome: A retrospective analysis from the Platelet Inhibition and Patient Outcomes (PLATO) Trial

Kang, Hyun–Jae; Clare, Robert; Gao, Runlin; Held, Claes; Himmelmänn, Anders; James, Stefan; Lim, Soo Teik; Santoso, Anwar; Yu, Cheuk Man; Wallentin, Lars; Becker, Richard C.

doi:10.1016/j.ahj.2015.03.015

Cited by 95 publications

(89 citation statements)

References 25 publications

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“…It was similar to the study from Lindholm et al, (2014) in patients with NSTE-ACS; the primary end point was better on ticagrelor compared to clopidogrel (10.0% vs. 12.3%, HR 0.83, CI 95% 0, 74-.93) [30]. However, this study differed from other studies such as Steg et al, (2010) and Kang et al, (2015) [31,32]. According to Steg et al, (2010) ticagrelor compared to clopidogrel therapy did not differ significantly in preventing the primary endpoint in patients with STEMI with PCI HR 0.87 (95% CI, 0.75 to 1.01, p = 0.07) [31], while study from Kang et al, (2015) showed us that ticagrelor therapy was not significantly different than clopidogrel in preventing the primary endpoint in patients who have CHD in Asia population [32].…”

Section: Discussioncontrasting

confidence: 52%

“…However, this study differed from other studies such as Steg et al, (2010) and Kang et al, (2015) [31,32]. According to Steg et al, (2010) ticagrelor compared to clopidogrel therapy did not differ significantly in preventing the primary endpoint in patients with STEMI with PCI HR 0.87 (95% CI, 0.75 to 1.01, p = 0.07) [31], while study from Kang et al, (2015) showed us that ticagrelor therapy was not significantly different than clopidogrel in preventing the primary endpoint in patients who have CHD in Asia population [32]. This could be due to differences in the characteristics of the subject, method, sample size, type of disease and some possible causes that could affect the results.…”

Section: Discussioncontrasting

confidence: 51%

“…Analysis of survival with one-year follow-up in myocardial infarction indicated that the clopidogrel had a higher risk of myocardial infarction but not significant with HR [32]. Analysis of survival in death for 1 y showed that betablocker therapy can reduce the risk of death.…”

Section: Discussionmentioning

confidence: 99%

“…Lindholm et al, (2014) showed that in patients with NSTE-ACS, the death incidence was better on ticagrelor compared to clopidogrel (4.3% vs 5.8%, HR 0.76, 95% CI 0.64 to 0.90) [31]. Kang et al, (2015) indicated that ticagrelor therapy was not significantly different than clopidogrel in preventing death in Asian patients who have CHD (HR 0.77, 95% CI 0.51 to 1.17) [32].…”

Section: Discussionmentioning

confidence: 99%

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Effectiveness of Ticagrelor Compared to Clopidogrel in Reducing the Risk of Major Adverse Cardiovascular Events in Patients With Coronary Heart Disease After Percutaneous Coronary Intervention

Nur’amin

Dwiprahasto

Kristin

2017

Int J Pharm Pharm Sci

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Objective: Antiplatelet therapy is recommended in patients with coronary heart disease (CHD) who had the percutaneous coronary intervention (PCI) procedure to reduce major adverse cardiovascular events (MACE). There has been a lack of population-based studies that showed the superior effectiveness of ticagrelor over clopidogrel and similar studies have not been conducted in Indonesia yet. The aim of the study was to investigate the effectiveness of ticagrelor compared to clopidogrel in reducing the risk of MACE in patients with CHD after PCI. Methods:A retrospective cohort study with 1-year follow-up was conducted. 361 patients consisted of 111 patients with ticagrelor exposure and 250 patients with clopidogrel exposure. The primary outcome was MACE, defined as a composite of repeat revascularization, myocardial infarction, or all-cause death. The association between antiplatelet exposure and the MACE was analyzed with Cox proportional hazard regression, adjusted for sex, age, comorbid, PCI procedures and concomitant therapy.Results: MACE occurred in 22.7% of the subjects. Clopidogrel had a significantly higher risk of MACE compared with ticagrelor (28.8%, vs 9.0%, hazard ratio (HR): 1.96 (95% CI 1.01 to 3.81, p=0.047). There were no significant differences in risk of repeat revascularization (20.40% vs 5.40%, HR: 2.32, 95% CI 0.99 to 5.42, p = 0.05), myocardial infarction (11.60% vs 3.60%, HR: 2.08, 95% CI, 0.73 to 5.93, p = 0.17), and death (1.60% vs 1.80%, HR: 0.77, 95% CI, 0.14 to 4.25, p = 0.77). Conclusion:Clopidogrel had a higher risk of MACE compared to clopidogrel in patients with CHD after PCI, but there were no significant differences in the risk of repeat revascularization, myocardial infarction, and all-cause death.

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Section: Discussioncontrasting

confidence: 52%

Section: Discussioncontrasting

confidence: 51%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Effectiveness of Ticagrelor Compared to Clopidogrel in Reducing the Risk of Major Adverse Cardiovascular Events in Patients With Coronary Heart Disease After Percutaneous Coronary Intervention

Nur’amin

Dwiprahasto

Kristin

2017

Int J Pharm Pharm Sci

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“…Using the cohort from the PLATO trial, there was no difference in bleeding events found in Asian subjects treated with ticagrelor compared to clopidogrel when compared to the rest of the study cohort [76]. The authors did note the relatively small Asian cohort relative to the entire study population.…”

Section: Platelet Aggregationmentioning

confidence: 99%

Ethnic Minorities and Coronary Heart Disease: an Update and Future Directions

Leigh

Alvarez

Rodríguez

2016

Curr Atheroscler Rep

132

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Heart disease remains the leading cause of death in the USA. Overall, heart disease accounts for about 1 in 4 deaths with coronary heart disease (CHD) being responsible for over 370,000 deaths per year. It has frequently and repeatedly been shown that some minority groups in the USA have higher rates of traditional CHD risk factors, different rates of treatment with revascularization procedures, and excess morbidity and mortality from CHD when compared to the non-Hispanic white population. Numerous investigations have been made into the causes of these disparities. This review aims to highlight the recent literature which examines CHD in ethnic minorities and future directions in research and care.

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Time Course for Benefit and Risk With Ticagrelor and Aspirin in Individuals With Acute Ischemic Stroke or Transient Ischemic Attack Who Carry CYP2C19 Loss-of-Function Alleles

et al. 2022

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IMPORTANCEDual antiplatelet therapy (DAPT) with ticagrelor and aspirin has been found to be effective for secondary prevention after minor ischemic stroke or transient ischemic attack (TIA) in individuals who carry CYP2C19 loss-of-function (LOF) alleles; however, uncertainties remain about the time course of benefit and risk with ticagrelor and aspirin in these patients.OBJECTIVE To obtain time-course estimates of efficacy and risk with ticagrelor and aspirin after minor stroke or TIA in individuals with CYP2C19 LOF alleles. DESIGN, SETTING, AND PARTICIPANTSThe Ticagrelor or Clopidogrel With Aspirin in High-risk Patients With Acute Nondisabling Cerebrovascular Events II (CHANCE-2) randomized clinical trial enrolled patients 40 years and older from 202 hospitals in China with acute minor stroke or TIA who carried CYP2C19 LOF alleles between September 23, 2019, and March 22, 2021, and were followed up for 90 days. All 6412 patients enrolled in the CHANCE-2 trial were included in this secondary analysis. Data were analyzed in October 2021.INTERVENTIONS Ticagrelor (180 mg on day 1 followed by 90 mg twice daily on days 2-90) or clopidogrel (300 mg on day 1 followed by 75 mg daily on days 2-90). All patients received aspirin (75-300 mg on day 1 followed by 75 mg daily for 21 days). MAIN OUTCOMES AND MEASURESThe efficacy outcome was major ischemic event, defined as the composite of ischemic stroke or nonhemorrhagic death. Safety outcomes included moderate to severe bleeding and any bleeding.RESULTS A total of 6412 patients were included (3205 in the ticagrelor and aspirin group and 3207 in the clopidogrel and aspirin group). The median (IQR) age was 65 (57-71) years, and 4242 patients (66%) were men. The reduction of major ischemic events with ticagrelor and aspirin predominately occurred in the first week (absolute risk reduction, 1.34%; 95% CI, 0.29 to 2.39) and attenuated but remained in the next 3 weeks (absolute risk reduction in the second week, 0.11%; 95% CI, −0.24 to 0.45; absolute risk reduction in the third week, 0.14%; 95% CI, −0.11 to 0.38; absolute risk reduction in the fourth week, 0.04%; 95% CI, −0.18 to 0.25). The risk of moderate to severe bleeding was consistently low in the ticagrelor and aspirin group. The absolute increase in any bleeding seen in the first week (0.87%; 95% CI, 0.25 to 1.50) remained in the next 3 weeks (absolute increase in the second week, 1.21%; 95% CI, 0.75 to 1.68; absolute increase in the third week, 0.33%; 95% CI, −0.05 to 0.72; absolute increase in the fourth week, 0.23%; 95% CI, −0.03 to 0.49).CONCLUSION AND RELEVANCE Among patients with minor stroke or TIA who carried CYP2C19 LOF alleles, benefit with ticagrelor and aspirin was present predominately in the first week, with additional small benefit accruing in the next 2 weeks.

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Ticagrelor versus clopidogrel in Asian patients with acute coronary syndrome: A retrospective analysis from the Platelet Inhibition and Patient Outcomes (PLATO) Trial

Abstract: We observed consistency of effects in Asian patients receiving ticagrelor and clopidogrel in the PLATO study. The relatively modest number of Asian patients in this analysis supports further investigation of larger cohorts to confirm our observations.

Cited by 95 publications

References 25 publications

Effectiveness of Ticagrelor Compared to Clopidogrel in Reducing the Risk of Major Adverse Cardiovascular Events in Patients With Coronary Heart Disease After Percutaneous Coronary Intervention

Effectiveness of Ticagrelor Compared to Clopidogrel in Reducing the Risk of Major Adverse Cardiovascular Events in Patients With Coronary Heart Disease After Percutaneous Coronary Intervention

Ethnic Minorities and Coronary Heart Disease: an Update and Future Directions

Time Course for Benefit and Risk With Ticagrelor and Aspirin in Individuals With Acute Ischemic Stroke or Transient Ischemic Attack Who Carry CYP2C19 Loss-of-Function Alleles

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