Clopidogrel, prasugrel, and ticagrelor for all-comers with ST-segment elevation myocardial infarction

Jacobsen, Mia Ravn; Engstrøm, Thomas; Torp‐Pedersen, Christian; Gislason, Gunnar; Glinge, Charlotte; Butt, Jawad H; Fosbøl, Emil Loldrup; Holmvang, Lene; Pedersen, Frants; Køber, Lars; Jabbari, Reza; Sørensen, Rikke

doi:10.1016/j.ijcard.2021.07.047

Cited by 5 publications

(2 citation statements)

References 18 publications

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“…Studies have shown that compared to clopidogrel, the more potent P2Y12 inhibitors, including prasugrel and ticagrelor, further reduced the risk of death, MI, and stroke in ACS patients ( 18 , 19 ). But, an increase in non-critical major bleeding risk was found in the patients with these more potent P2Y12 inhibitors, which might indicate a trade-off between the anti-thrombotic benefit and the bleeding side effects ( 20 ).…”

Section: Discussionmentioning

confidence: 99%

Comparing the effectiveness and safety of dual antiplatelet with ticagrelor or clopidogrel in elderly Asian patients with acute myocardial infraction

Yeh

Chen²,

Tomlinson³

et al. 2023

Front. Cardiovasc. Med.

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BackgroundCurrent guidelines recommend potent P2Y12 inhibitors for patients after acute coronary syndrome. However, the data on the efficacy and safety of potent P2Y12 inhibitors in elderly Asian populations was limited. We aimed to investigate the major adverse cardiovascular events (MACE), bleeding events, and net adverse clinical events (NACE) with ticagrelor and clopidogrel in Taiwanese patients aged 65 and older after acute myocardial infarction (AMI).MethodsThis retrospective population-based cohort study was conducted using data from the National Health Insurance Research Database. The AMI patients aged ≥65 years who underwent percutaneous coronary intervention (PCI) and survived after 1 month were included. The patients were separated into 2 cohorts depending on the type of dual antiplatelet therapy (DAPT) they received: ticagrelor plus aspirin (T + A) or clopidogrel plus aspirin (C + A). We used inverse probability of treatment weighting to balance the difference between these 2 study groups. The outcome included all-cause mortality, MACE (cardiovascular death, nonfatal ischemic stroke, and nonfatal myocardial infarction), intracerebral hemorrhage, major bleeding, and NACE which is composed of cardiovascular death, ischemic and hemorrhagic events. The follow-up period was up to 12 months.ResultsFrom 2013 to 2017, a total of 14,715 patients who met the eligibility criteria were separated into 2 groups: 5,051 for T + A and 9,664 for C + A. Compared to patients with C + A, patients who received T + A had a lower risk of cardiovascular death and all-cause death, with an adjusted HR of 0.57 [95% confidence interval (CI), 0.38–0.85, p = 0.006] and 0.58 (95% CI 0.45–0.74, p < 0.001), respectively. No differences were found in MACE, intracranial and major bleeding between the 2 groups. In addition, the patients with T + A had a lower risk of NACE with an adjusted HR of 0.86 (95% CI 0.74–1.00, p = 0.045)ConclusionAmong elderly AMI patients receiving DAPT after successful PCI, ticagrelor was a more favorable P2Y12 inhibitor than clopidogrel because of lowering the risk of death and NACE without increasing the risk of severe bleeding. Ticagrelor is an effective and safe P2Y12 inhibitor in Asian elderly survivors after PCI.

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Section: Discussionmentioning

confidence: 99%

Comparing the effectiveness and safety of dual antiplatelet with ticagrelor or clopidogrel in elderly Asian patients with acute myocardial infraction

Yeh

Chen²,

Tomlinson³

et al. 2023

Front. Cardiovasc. Med.

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“…They are used in the long-term prevention of cardiovascular and cerebrovascular events. However, prior studies have documented individual differences in platelet response to aspirin and ticagrelor on platelet aggregation. − Aspirin and ticagrelor resistance can lead to potentially severe consequences such as recurrent myocardial infarction, stroke, or death; − thus, it is highly valuable to develop a monitoring method in vitro to guide patient-specific therapy. The platelet function assays are beneficial for investigating patients with suspected platelet disorders and evaluating the effects of antiplatelet drugs.…”

Section: Introductionmentioning

confidence: 99%

Rapid and Nondestructive Evaluation of Platelet Function in Whole Blood by Microfluidic Deterministic Cytometry

Chen,

Deng,

Zhang

et al. 2023

Anal. Chem.

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Platelet size is a determinant of platelet function.Here, a new microfluidic deterministic cytometry packed with Sshaped micropillars (S-MDC) was developed to rapidly and sensitively determine the apparent size (D app ) of platelets, which was used to evaluate platelet function. The platelet D app in the diluted whole blood was rapidly and label-freely measured by S-MDC within 2 min under shear rates (0.4 mm/s) that mimicked physiological conditions. The level of CD62p on platelets scarcely changed before and after platelets went through the whole S-MDC, indicating that the platelet function was nondestructive. Notably, the human platelet D app determined before and after thrombin addition by S-MDC was highly coincident with the levels of CD62p on the platelet surface by flow cytometry (r = 0.819), revealing that the human platelet D app was available to assess the platelet activation state. In addition, the results of the rat platelet D app were consistent with myocardial injury of rats with myocardial ischemia before and after treatment with antiplatelet agents, suggesting that rat platelet D app can be used to reflect myocardial injury in vivo outcomes. These findings reveal that S-MDC is a promising technique for screening tests for a bleeding disorder, in addition to monitoring antiplatelet drugs.

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Ticagrelor or Clopidogrel as Antiplatelet Agents in Patients with Chronic Kidney Disease and Cardiovascular Disease: A Meta-analysis

Guo,

Ge,

et al. 2023

Am J Cardiovasc Drugs

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Clopidogrel, prasugrel, and ticagrelor for all-comers with ST-segment elevation myocardial infarction

Cited by 5 publications

References 18 publications

Comparing the effectiveness and safety of dual antiplatelet with ticagrelor or clopidogrel in elderly Asian patients with acute myocardial infraction

Comparing the effectiveness and safety of dual antiplatelet with ticagrelor or clopidogrel in elderly Asian patients with acute myocardial infraction

Rapid and Nondestructive Evaluation of Platelet Function in Whole Blood by Microfluidic Deterministic Cytometry

Ticagrelor or Clopidogrel as Antiplatelet Agents in Patients with Chronic Kidney Disease and Cardiovascular Disease: A Meta-analysis

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