Among antithrombotic agents, prasugrel, but not ticagrelor, is associated with reduced 30day mortality in patients with ST-elevated myocardial infarction

Serebruany, Victor L.; Cherepanov, Vasily; Tomek, Aleš; Kim, Moo Hyun

doi:10.1016/j.ijcard.2015.05.062

Cited by 12 publications

(8 citation statements)

References 24 publications

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“… 23) Furthermore, a meta-analysis including 10 randomized controlled trials and one large retrospective study drew the conclusion that prasugrel, but not ticagrelor, offered a significant reduction in 30-day mortality in PCI-treated STEMI patients. 24) These results justify the utilization of prasugrel for patients who underwent revascularization.…”

Section: Discussionmentioning

confidence: 92%

The Use Pattern and Clinical Impact of New Antiplatelet Agents Including Prasugrel and Ticagrelor on 30-day Outcomes after Acute Myocardial Infarction in Korea: Korean Health Insurance Review and Assessment Data

et al. 2017

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Background and ObjectivesDespite the favorable efficacy of new antiplatelet agents demonstrated in randomized controlled trials, their clinical implications in Korea are unclear. The purpose of this study was to investigate trends in antiplatelet agent use for acute myocardial infarction (AMI) and their impact on 30-day clinical outcomes.MethodsAMI patients undergoing percutaneous coronary intervention between 2010 and 2015 were assessed using claim data from the Health Insurance Review and Assessment Service.ResultsThe use of new antiplatelet agents has rapidly increased since 2013 and has been preferred over clopidogrel (Plavix; Bristol-Myers Squibb/Sanofi Pharmaceuticals) since 2015. Both prasugrel (Effient; Eli Lilly and Company) (odds ratio [OR], 0.45; 95% confidence interval [CI], 0.31–0.67; p<0.001) and ticagrelor (Brilinta; AstraZeneca Pharmaceuticals LP) (OR, 0.84; 95% CI, 0.71–0.98; p=0.032) had an independent effect on lowering 30-day mortality in a weighted multivariable logistic regression model. However, new antiplatelet agents had no significant effect on other clinical outcomes including myocardial infarction, stroke, bleeding, and readmission within 30 days.ConclusionThe use of new antiplatelet agents is rapidly increasing, and they have been used more commonly than clopidogrel since 2015. We demonstrated that new antiplatelet agents have a favorable effect on reducing 30-day mortality in AMI patients in Korea.

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Section: Discussionmentioning

confidence: 92%

The Use Pattern and Clinical Impact of New Antiplatelet Agents Including Prasugrel and Ticagrelor on 30-day Outcomes after Acute Myocardial Infarction in Korea: Korean Health Insurance Review and Assessment Data

et al. 2017

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“…For patients with non-ST segment elevation acute coronary syndrome, results of a subsequent meta-analysis of 4 RCTs indicated that a novel P2Y 12 antiplatelet was associated with a significantly reduced rate of MACE compared with clopidogrel (risk ratio [RR] = 0.87), but the incidences of major and minor bleeding events were significantly higher (RR = 1.27, 1.20) [14]. For patients with STEMI, results of 3 meta-analyses of RCTs consistently indicated that prasugrel and ticagrelor were more efficacious than clopidogrel for reducing the risk of MACE, although the rates of bleeding events were similar [15][16][17].…”

Section: Discussionmentioning

confidence: 99%

“…Regarding the relative efficacies of prasugrel and ticagrelor-based antiplatelet regimens for patients with STEMI undergoing PCI, results of previous findings may provide some evidence. Serebruany et al [17] found that prasugrel, but not ticagrelor, offers a significant 30-day mortality benefit over clopidogrel in PCI-treated STEMI patients. This was confirmed by a subsequent metaanalysis, which showed that for STEMI patients undergoing PCI, prasugrel was superior to ticagrelor, particularly in conjunction with bivalirudin and drug-eluting stents [15].…”

Section: Discussionmentioning

confidence: 99%

Prasugrel or ticagrelor relative to clopidogrel in triple-antiplatelet treatment combined with glycoprotein IIb/IIIa inhibitor for patients with STEMI undergoing PCI: a meta-analysis

Wang¹,

Zhou²,

Su³

et al. 2020

BMC Cardiovasc Disord

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Background: For patients with ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI), the efficacy and safety of novel P2Y 12 antagonists, including prasugrel or ticagrelor, has not been established relative to that of the clopidogrel-based triple-antiplatelet treatments (TAPTs; in combination with glycoprotein IIb/IIIa inhibitor). The present meta-analysis evaluated the efficacy and safety of prasugrel-or ticagrelor-based TAPTs relative to that of clopidogrel TAPTs in patients with STEMI undergoing PCI. Methods: The databases PubMed, Embase, and Cochrane's Library were systematically searched for relevant randomized controlled trials concerning prasugrel or ticagrelor (test) relative to clopidogrel (control). Depending on heterogeneity, studies were pooled with a random effects or a fixed effects model. Outcomes of blood flow after PCI were evaluated, including TIMI (thrombolysis in myocardial infarction), bleeding events, and major adverse cardiovascular events (MACEs). Results: Seven studies comprising 11,874 patients conformed to the inclusion criteria. The pooled results with the fixed effects model indicated that after PCI patients in the prasugrel or ticagrelor groups were as likely as those treated with clopidogrel to achieve TIMI grade 3 flow or experience bleeding events. However, compared with the control, the test groups had significantly less risk of MACE (OR: 0.81, 95% CI: 0.70-0.94, P = 0.004), especially at the 1-year follow-up (OR: 0.79, 95% CI: 0.66-0.95, P = 0.01). Conclusions: A prasugrel-or ticagrelor-based TAPT may reduce the rate of MACEs, without increasing bleeding in STEMI patients undergoing PCI. However, due to the limited RCT studies and variations in study weight, results of this metaanalysis should be confirmed in a large RCT with adequate sample size and follow-up duration.

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“…There seems to be conflicting research in regards to ticagrelor having excess bleeding risks [3,9]. The PLATO trial led to ticagrelor implementation into clinical practice around the world [10]. Some experts argue that the Federal Drug Association was too fast to allow ticagrelor into the market with only one significant trial (PLATO) showing decreased mortality in treated patients [10].…”

Section: Introductionmentioning

confidence: 99%

“…The PLATO trial led to ticagrelor implementation into clinical practice around the world [10]. Some experts argue that the Federal Drug Association was too fast to allow ticagrelor into the market with only one significant trial (PLATO) showing decreased mortality in treated patients [10]. The increased use of ticagrelor in antiplatelet management quantifies the need to establish whether this drug is better than the conventional dual antiplatelet therapy.…”

Section: Introductionmentioning

confidence: 99%

Ticagrelor versus clopidogrel in the management of acute myocardial infarction

Volney¹,

Collins²,

Adams³

2019

Journal of Community Hospital Internal Medicine Perspectives

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Hypothesis: In the care of acute myocardial infarction, ticagrelor attenuates post-ischemic myocardial damage and inhibits platelet activity to a greater extent than clopidogrel. Methods: Scholarly articles published in the last 10 years were compiled from a PubMed MeSH search focusing on acute coronary infarction and the antiplatelet therapies clopidogrel and ticagrelor. The databases used were PubMed, Google Scholar, Dynamed, and EBSCOhost. Eight articles were chosen based on subject matter related to the hypothesis, including cardioprotective effects, mortality benefits, platelet reactivity, angiographic effects, and electrocardiography changes. Results: Evidence from randomized clinical trials demonstrates that ticagrelor reduces infarct size, prevents remodeling, and reduces mortality rate after acute myocardial infarction to a greater extent than clopidogrel. However, some angiography studies show no difference between the two treatment regimes. Two articles show that ticagrelor is more effective in treating individuals with high platelet reactivity (HPR). In addition, there is some evidence of increased dyspnea and significant bleeding with ticagrelor. Discussion: Although there is growing evidence that ticagrelor is the better antiplatelet drug post-acute coronary infarction, more research needs to be done to determine the situations in which ticagrelor provides the optimal treatment regime in regards to cardioprotective effects, antiplatelet effects and an overall decrease in mortality. Conclusion: Ticagrelor was found to be superior to clopidogrel in relation to cardioprotective effects, mortality, and antiplatelet activity.

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Among antithrombotic agents, prasugrel, but not ticagrelor, is associated with reduced 30day mortality in patients with ST-elevated myocardial infarction

Cited by 12 publications

References 24 publications

The Use Pattern and Clinical Impact of New Antiplatelet Agents Including Prasugrel and Ticagrelor on 30-day Outcomes after Acute Myocardial Infarction in Korea: Korean Health Insurance Review and Assessment Data

The Use Pattern and Clinical Impact of New Antiplatelet Agents Including Prasugrel and Ticagrelor on 30-day Outcomes after Acute Myocardial Infarction in Korea: Korean Health Insurance Review and Assessment Data

Prasugrel or ticagrelor relative to clopidogrel in triple-antiplatelet treatment combined with glycoprotein IIb/IIIa inhibitor for patients with STEMI undergoing PCI: a meta-analysis

Ticagrelor versus clopidogrel in the management of acute myocardial infarction

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