Ticagrelor versus clopidogrel after fibrinolytic therapy in patients with ST-elevation myocardial infarction: Rationale and design of the ticagrelor in patients with ST elevation myocardial infarction treated with thrombolysis (TREAT) trial

Berwanger, Otávio; Nicolau, José Carlos; Carvalho, Antônio Carlos; Jiang, Lixin; Goodman, Shaun G.; Nicholls, Stephen J.; Parkhomenko, Alexander; Ov, Averkov; Tajer, Carlos; Málaga, Germán; Saraiva, José Francisco Kerr; Fonseca, Francisco A.; Guimarães, Hélio Penna; Silva, Pedro Gabriel Melo de Barros e; Damiani, Lucas Petri; Paisani, Denise M.; Lasagno, Camila M. R.; Candido, Carolina T.; Valeis, Nanci; Moia, Diogo D.F.; Piegas, Leopoldo Soares; Granger, Christopher B.; White, Harvey D.; Lópes, Renato D.

doi:10.1016/j.ahj.2018.02.017

Cited by 15 publications

(19 citation statements)

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“…Связано это с тем, что в исследованиях, посвященных оценке целесообразности предпочтительного (клопидогрелу) использования празугрела и тикагрелора при ИМпST, больные, получившие тромболитик, адекватно представлены не были [5,6]. Устранить пробел в доказательствах возможности раннего применения тикагрелора у больных, получивших ТЛ, было призвано исследование TREAT [7], промежуточные результаты которого в виде сравнения эффектов тикагрелора и клопидогрела за 30 дней наблюдения у больных ИМпST, получивших ТЛ [7], обсуждались нами ранее [8]. До появления этих результатов Европейские рекомендации по ведению больных ИМпST от 2017г допускали переход на БP2Y 12 только после своеобразного периода безопасности, ограниченного 48 ч (после введения тромболитика) [2].…”

Section: основания для отдельной оценки частоты геморрагических и ишеunclassified

“…До появления этих результатов Европейские рекомендации по ведению больных ИМпST от 2017г допускали переход на БP2Y 12 только после своеобразного периода безопасности, ограниченного 48 ч (после введения тромболитика) [2]. Приемлемая геморрагическая безопасность без потери эффективности при более раннем переходе (в пределах 24 ч от начала симптомов) с клопидогрела на тикагрелор у больных ИМпST, получивших ТЛ, была показана в итогах 30-дневного наблюдения в исследовании TREAT [7]. Выяснилось, что у обсуждаемой категории больных серьезной геморрагической угрозы назначение тикагрелора вместо клопидогрела не несет.…”

Section: основания для отдельной оценки частоты геморрагических и ишеunclassified

“…При рандомизации больные получали нагрузочную дозу исследуемого препарата (тикагрелор: 180 мг, клопидогрел: 300 мг) с дальнейшим переходом на поддерживающие дозы (тикагрелор: 90 мг дважды еже дневно, клопидогрел: 75 мг 1 раз в день). Принципиально важно, что применение исследуемых препаратов (тикагрелора и клопидогрела) происходило не в момент введения тромболитика и не сразу после мени требовалось продолжать сравниваемое лечение в исследовании TREAT [7]. Вполне очевидно, что длительность экспозиции к более мощному БP2Y 12 тикагрелору, способная сказаться на риске кровотечения, определяла необходимость анализа безопасности и эффективности за весь период сравнения тикагрелора и клопидогрела.…”

Section: краткое изложение замысла и методологии исследования Treatunclassified

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Selection of P2Y12 antagonist in patients with myocardial infarction who received thrombolytic therapy. Results of annual follow-up of TREAT study patients

Аверков

Вечорко

2019

Russ J Cardiol

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Dual antiplatelet therapy serves to improve the clinical results of thrombolytic therapy after STEMI, until recently consisted of acetylsalicylic acid and clopidogrel. In this category of patients, ticagrelor, widely used by acute coronary syndrome as more effective than clopidogrel, had no serious evidence of efficacy and safety. The TREAT study discussed in this article has been implemented to supply a gap in the evidence base of ticagrelor. The results of observation within 12 months after randomization to taking ticagrelor or clopidogrel of patients who received thrombolytic showed that the hemorrhagic safety regarding the major bleeding of ticagrelor is comparable with clopidogrel. The results of the TREAT study with the previously obtained results of the PLATO study make it possible to broaden indications for the use of ticagrelor (or switching from clopidogrel) in the first 24 hours from the onset of a myocardial infarction in patients who received thrombolytic therapy as an initial reperfusion.

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Section: основания для отдельной оценки частоты геморрагических и ишеunclassified

Section: краткое изложение замысла и методологии исследования Treatunclassified

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Selection of P2Y12 antagonist in patients with myocardial infarction who received thrombolytic therapy. Results of annual follow-up of TREAT study patients

Аверков

Вечорко

2019

Russ J Cardiol

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“…The TREAT study (NCT02298088) has been designed to provide evidence regarding the safety of ticagrelor relative to clopidogrel in patients with STEMI treated with fibrinolytics . TREAT is an international, phase 3 study run by the Research Institute of the Hospital do Coração, São Paulo, Brazil.…”

Section: Treat Studymentioning

confidence: 99%

“… TREAT study design. Reproduced from Berwanger et al 2018 . Abbreviations: STEMI, ST‐segment elevation myocardial infarction …”

Section: Treat Studymentioning

confidence: 99%

Use of ticagrelor alongside fibrinolytic therapy in patients with ST‐segment elevation myocardial infarction: Practical perspectives based on data from the TREAT study

Berwanger

Abdelhamid

Alexander

et al. 2018

Clinical Cardiology

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Primary percutaneous coronary intervention (PCI) is the preferred reperfusion method in patients with ST-segment elevation myocardial infarction (STEMI). In patients with STEMI who cannot undergo timely primary PCI, pharmacoinvasive treatment is recommended, comprising immediate fibrinolytic therapy with subsequent coronary angiography and rescue PCI if needed. Improving clinical outcomes following fibrinolysis remains of great importance for the many patients globally for whom rapid treatment with primary PCI is not possible. For patients with acute coronary syndrome who underwent primary PCI, the PLATO trial demonstrated superior efficacy of ticagrelor relative to clopidogrel. Results in the predefined subgroup of patients with STEMI were consistent with the overall PLATO trial. Patients who received fibrinolytic therapy in the 24 hours before randomization were excluded from PLATO, and there is thus a lack of data on the safety of using ticagrelor in conjunction with fibrinolytic therapy in the first 24 hours after STEMI. The TREAT study addresses this knowledge gap; patients with STEMI who had symptom onset within the previous 24 hours and had received fibrinolytic therapy (of whom 89.4% had also received clopidogrel) were randomized to treatment with ticagrelor or clopidogrel (median time between fibrinolysis and randomization: 11.5 hours). At 30 days, ticagrelor was found to be non-inferior to clopidogrel for the primary safety outcome of Thrombolysis in Myocardial Infarction (TIMI)-defined first major bleeding. Considering together the results of the PLATO and TREAT studies, initiating or switching to treatment with ticagrelor within the first 24 hours after STEMI in patients receiving fibrinolysis is reasonable.

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Ticagrelor vs Clopidogrel After Fibrinolytic Therapy in Patients With ST-Elevation Myocardial Infarction

et al. 2018

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Ticagrelor versus clopidogrel after fibrinolytic therapy in patients with ST-elevation myocardial infarction: Rationale and design of the ticagrelor in patients with ST elevation myocardial infarction treated with thrombolysis (TREAT) trial

Cited by 15 publications

References 15 publications

Selection of P2Y12 antagonist in patients with myocardial infarction who received thrombolytic therapy. Results of annual follow-up of TREAT study patients

Selection of P2Y12 antagonist in patients with myocardial infarction who received thrombolytic therapy. Results of annual follow-up of TREAT study patients

Use of ticagrelor alongside fibrinolytic therapy in patients with ST‐segment elevation myocardial infarction: Practical perspectives based on data from the TREAT study

Ticagrelor vs Clopidogrel After Fibrinolytic Therapy in Patients With ST-Elevation Myocardial Infarction

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