Ticagrelor better than clopidogrel in ACS with early invasive strategy

January 01, 0001

Ticagrelor better than clopidogrel in ACS with early invasive strategy

Variation in and irreversibility of platelet inhibition with clopidogrel has led to controversy about its optimum dose and timing of administration in patients with acute coronary syndromes (ACS). The researchers from the multiple compared ticagrelor, a more potent reversible P2Y12 inhibitor with clopidogrel in such patients. At randomisation, an invasive strategy was planned for 13 408 (72·0%) of 18 624 patients hospitalised for ACS (with or without ST elevation). Patients were randomly assigned to ticagrelor and placebo (180 mg loading dose followed by 90 mg twice a day), or to clopidogrel and placebo (300—600 mg loading dose or continuation with maintenance dose followed by 75 mg per day) for 6—12 months. All patients were given aspirin. 6732 patients were assigned to ticagrelor and 6676 to clopidogrel. The primary composite endpoint was cardiovascular death, myocardial infarction, or stroke.

The primary composite endpoint occurred in fewer patients in the ticagrelor group than in the clopidogrel group (event rate at 360 days 9·0% vs 10·7%, hazard ratio 0·84, significant). There was no difference between clopidogrel and ticagrelor groups in the rates of total major bleeding (11·6% vs 11·5%, HR 0·99, not significant) or severe bleeding, 3·2% vs 2·9%, HR 0·91, not significant).

The researchers concluded: "Ticagrelor seems to be a better option than clopidogrel for patients with acute coronary syndromes for whom an early invasive strategy is planned."

Important, although bleeding is still an issue.

For the full abstract, click here.

The Lancet 375(9711): 283 - 293, 23 January 2010, doi:10.1016/S0140-6736(09)62191-7)
© 2010 Elsevier Ltd
Comparison of ticagrelor with clopidogrel in patients with a planned invasive strategy for acute coronary syndromes (PLATO): a randomised double- blind study. Christopher P Cannon, Robert A Harrington, Stefan James, et al for the PLATelet inhibition and patient Outcomes (PLATO) investigators. Correspondence to: Christopher Cannon: [email protected]

Category: K. Circulatory Keywords: ticagrelor, clopidogrel, comparison, acute coronary syndromes, randomized double blind study, journal watch.
Synopsis edited by Dr Stephen Wilkinson, Melbourne, Australia. Posted on Global Family Doctor 28 January 2010

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.