Clopidogrel is safer than ticagrelor in regard to bleeds: A closer look at the PLATO trial

DiNicolantonio, James J.; D’Ascenzo, Fabrizio; Tomek, Aleš; Chatterjee, Saurav; Niazi, Asfandyar Khan; Biondi‐Zoccai, Giuseppe

doi:10.1016/j.ijcard.2013.06.135

Cited by 56 publications

(45 citation statements)

References 12 publications

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“…Bleeding complications have always been an issue of concern for cardiovascular physicians when using TAPT [15,[20][21][22], particularly in diabetic patients with AMI; in this study, patients in both groups A and B had no serious bleeding events, indicating that it is essential to monitor bleeding caused by the administration of GP IIb/IIIa receptor antagonists and ticagrelor, especially when these two agents are combined. Although the incidence among these three groups did not reach statistical significance, severe bleeding is a high-risk complication, and clinicians should closely monitor patients when combining these agents, and reduce the dose when necessary [23].…”

Section: Discussionmentioning

confidence: 76%

“…Furthermore, timely blood tests should be performed. The risk factors for bleeding combined with the administration of GP IIb/IIIa receptor antagonists is potentially the main reason underlying this effect [22,24]. With regard to differences in the efficacy and side effects when the second-generation P2Y12 receptor inhibitor clopidogrel and ticagrelor are combined with tirofiban [25], DiNicolantonio et al [22] thought that although ticagrelor had a faster onset and more persistent antiplatelet effects than clopidogrel, it could significantly increase the occurrence of adverse events such as intracranial haemorrhage, haematuria, subcutaneous bleeding, and mucosal bleeding .…”

Section: Discussionmentioning

confidence: 99%

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Short-term efficacy and safety of three different antiplatelet regimens in diabetic patients treated with primary percutaneous coronary intervention: a randomised study

Liu¹,

Liu

Hao

et al. 2017

Kardiol Pol

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A b s t r a c t Background and aim:This study aimed to investigate the efficacy and safety of dual and triple antiplatelet therapy (DAPT and TAPT) in patients with diabetes and acute ST segment elevation myocardial infarction (D-STEMI), who had undergone primary percutaneous coronary intervention (PCI). Methods:We designed a phase IV, single-centre, randomised, double-blind, placebo-controlled study. The D-STEMI patients (n = 258) were randomly divided into three groups. Control group A (85 patients), was treated with aspirin and clopidogrel; group B (87 patients) received aspirin, clopidogrel, and tirofiban; and group C (86 patients) were treated with aspirin, ticagrelor, and tirofiban. Patients in all three groups received oral DAPT, and patients in groups B and C received intravenous tirofiban when primary PCI was performed.Results: Compared to the findings in group A, the post-PCI Thrombolysis in Myocardial Infarction (TIMI) grade 3 blood flow in groups B and C increased significantly (TIMI grade 3 in groups A, B, C: 74%, 91%, and 98%, respectively; TIMI myocardial perfusion grade [TMPG] grade 3 in groups A, B, C: 59%, 86%, and 97%, respectively), and the incidence of major adverse cardiac events (MACE) decreased significantly (p < 0.05). Compared to the findings in group B, the rate of TMPG 3 in group C was significantly higher (p < 0.05) and the incidence of MACE was significantly lower (p < 0.05). Patients in group B exhibited minor bleeding; however, the incidence of mild to moderate bleeding in group C increased significantly (p < 0.05).Conclusions: TAPT effectively improved the TIMI blood flow and TMPG and reduced the occurrence of MACE. Ticagrelor was more effective than clopidogrel in TAPT; however, when using the combination of aspirin, ticagrelor, and tirofiban, close monitoring is required for possible bleeding complications.

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Section: Discussionmentioning

confidence: 76%

Section: Discussionmentioning

confidence: 99%

Short-term efficacy and safety of three different antiplatelet regimens in diabetic patients treated with primary percutaneous coronary intervention: a randomised study

Liu¹,

Liu

Hao

et al. 2017

Kardiol Pol

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“…И это «равенство» по геморрагической безопасности, как сказано выше, явля-ется одним из объяснений преимущества тикагрелора на уровне общей смертности и главной конечной точки исследования за счет его большего влияния на риск нефатальных ишемических событий. Учитывая общепри-знанное большее подавление активности тромбоцитов при использовании тикагрелора, одинаковая геморраги-ческая безопасность его и клопидогрела вызывает серьезные сомнения [11,12]. Дело в том, что важной особенностью учета и сравнения частоты крупных кро-вотечений в исследовании PLATO было включение в анализируемые кровотечения кровопотерь во время операций коронарного шунтирования (КШ).…”

Section: детали сравнения геморрагической безопасности тикагрелора и unclassified

“…3), т. е. в относительных цифрах увеличение риска этих крупных кровотечений при сравнении с риском таких же кровотечений в груп-пе клопидогрела составило около 100%. Разница в частоте внутричерепных кровотечений (27 случаев в группе тикагрелора против 14 случаев в группе клопи-догрела) статистически значима: ОР 1,87; 95% ДИ 1,02-3,42 [11]. Дополнительное замешательство в отношении сравнения риска развития внутричерепных кровотече-ний в исследовании PLATO вносят противоречия в сообщения об этих событиях в разных источниках.…”

Section: детали сравнения геморрагической безопасности тикагрелора и unclassified

“…Дополнительное замешательство в отношении сравнения риска развития внутричерепных кровотече-ний в исследовании PLATO вносят противоречия в сообщения об этих событиях в разных источниках. Помимо упомянутых выше 27 случаев у получавших тикагрелор против 14 у получавших клопидогрел в ана-лизе явных сторонников клопидогрела [11], есть и дру-гие цифры: 26 и 14 [6], 26 и 15 [10], 28 и 17 [14] внутри-черепных кровотечений у получавших тикагрелор и клопидогрел соответственно. Примечательно, что из 13 фатальных внутричерепных кровотечений 11 случились в группе тикагрелора и только 2 у получавших клопидо-грел [10].…”

Section: детали сравнения геморрагической безопасности тикагрелора и unclassified

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Anti-Thrombocytic Drugs for Acute Coronary Syndrome: Direct Comparison of Hemorrhagic Safety Thrombocyte P2y12-Receptor Blockers Ticagrelor and Clopidrogel (Based on Plato Study Results

Аверков¹

2016

Med. sov.

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КАРДИОЛОГИЯ РЕЗУЛЬТАТЫ ИССЛЕДОВАНИЯ PLATO [6] КАК ОСНОВАНИЕ ДЛЯ ПРЕДПОЧТИТЕЛЬНОГО ИСПОЛЬЗОВАНИЯ ТИКАГРЕЛОРА18 624 больных, госпитализированных с ОКС (с подъ-емами или без подъемов сегмента ST), используя двой-ной слепой метод и рандомизацию, были разделены на 2 группы. В одной из них применялось стандартное лече-ние, частью которого был клопидогрел (300 мг -нагру-зочная доза для большинства больных, затем 75 мг/сут), в другой вместо клопидогрела использовался тикагрелор (180 мг нагрузочная доза, затем 90 мг 2 р/сут). Длитель-ность сравнения около 12 месяцев. Основная конечная точка при оценке эффективности включала смерть от сердечно-сосудистых причин, инфаркт миокарда (ИМ) или инсульт. В итоге исследования суммарная частота этих событий составила 9,8% у получавших тикагрелор и 11,7% у получавших клопидогрел (отношение рисков, 0,84; 95% ДИ [0,77 до 0,92; p < 0,001]). Отмечена стати-стически значимая разница по частоте ИМ (5,8% в группе тикагрелора против 6,9% в группе клопидогрела, p = 0,005) и смерти от сердечно-сосудистых сосудистых причин (4,0% против 5,1%, p = 0,001). Наиболее весомой находкой исследования оказалась разница в частоте случаев смерти от всех причины (4,5%, в группе тикагре- O.V. AVERKOV, MD, Filatov Municipal Clinical Hospital No.15, Moscow ANTI-THROMBOCYTIC DRUGS FOR ACUTE CORONARY SYNDROME: DIRECT COMPARISON OF HEMORRHAGIC SAFETY THROMBOCYTE P2Y 12 -RECEPTOR BLOCKERS TICAGRELOR AND CLOPIDROGEL (BASED ON PLATO STUDY RESULTS)Double anti-platelet therapy (DAPT) comprising a combination of acetylsalicylic acid and one of the thrombocyte P2Y 12-receptor blockers is considered an obligatory element of the acute coronary syndrome (ACS) therapy [1-5]. Enlargement of the antiplatelet drugs range with active implementation of ticagrelor and prasugrel led to questions in cardiologists who render medical aid to acute coronary syndrome patients. Despite the priority use of these drugs declared in recommendations instead of clopidrogel doctors practically daily face a necessity to choose the optimal P2Y 12 blocking agent assessing the expected individual effectiveness, hemorrhagic safety and cost of the rather long-acting therapy. For doctors practicing in the territory of the RF as opposed to doctors in other countries the problem of the P2Y 12 blocking agent is less large-scale as they have to choose only between ticagrelor and clopidrogel (prasugrel is not applied in the RF).

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Antiplatelet agents for chronic kidney disease

Natale

Palmer

Saglimbene

et al. 2022

Cochrane Database of Systematic Reviews

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Clopidogrel is safer than ticagrelor in regard to bleeds: A closer look at the PLATO trial

Cited by 56 publications

References 12 publications

Short-term efficacy and safety of three different antiplatelet regimens in diabetic patients treated with primary percutaneous coronary intervention: a randomised study

Short-term efficacy and safety of three different antiplatelet regimens in diabetic patients treated with primary percutaneous coronary intervention: a randomised study

Anti-Thrombocytic Drugs for Acute Coronary Syndrome: Direct Comparison of Hemorrhagic Safety Thrombocyte P2y12-Receptor Blockers Ticagrelor and Clopidrogel (Based on Plato Study Results

Antiplatelet agents for chronic kidney disease

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