Efficacy and safety comparing prasugrel/ticagrelor and clopidogrel in Hong Kong post‐acute coronary syndrome patients–A 10‐year cohort study

Abstract

Background Clinical evidence of prasugrel/ticagrelor in dual antiplatelet therapy (DAPT) in Asian acute coronary syndrome (ACS) population remains inconclusive. We aimed to compare the clinical efficacy and safety of prasugrel/ticagrelor compared to clopidogrel as part of DAPT in Hong Kong ACS population for 10 years. Hypothesis Prasugrel/ticagrelor, compared to clopidogrel, reduces risk of major adverse cardiovascular event (MACE) in Hong Kong ACS population. Methods The retrospective observational cohort study included patients admitted to seven institutions under Hospital Authority Hong Kong with diagnosis of ACS during 2008–2017. Risk of MACE, defined as composite of cardiovascular (CV) death, non‐fatal myocardial infarction (MI) and non‐fatal stroke, and risk of any bleeding leading to hospitalization were examined. Baseline characteristics difference was adjusted by propensity score (PS) matching. Adjusted Cox regression model was used to estimate hazard ratio of interested outcome. Results In PS matched cohort including 944 patients in each group, MACE risk reduction of 40% from 1 year to 5 years after index ACS event was observed in prasugrel/ticagrelor group (HR 0.60, 95% CI 0.39–0.91, p = .015). The risk reduction was highly driven by MI reduction (HR 0.54, 95% CI 0.33–0.91, p = .019). Lower bleeding risk was observed in prasugrel/ticagrelor group compared to clopidogrel from 1 year to 5 years (HR 0.46, 95% CI 0.21–1.00, p = .051). Conclusions Prasugrel/ticagrelor showed MACE risk reduction over clopidogrel as part of DAPT up to 5 years after index event, while prasugrel/ticagrelor was not associated with increased bleeding risk.

The Signaling Pathway of the ADP Receptor P2Y12 in the Immune System: Recent Discoveries and New Challenges

“…It is usually administered at a lower dose. Prasugrel has shown higher bleeding risks than other antiplatelet drugs [ 77 ] but this has not been noted in all the studies [ 78 ]. This discrepancy needs to be taken into consideration when prescribed.…”

“…Moreover, the binding of ticagrelor to P2Y 12 is reversible with a faster offset of platelet inhibition than clopidogrel [ 81 ]. Ticagrelor has shown higher bleeding [ 78 ] than clopidogrel but not consistently in all studies [ 82 ]. Ticagrelor has also the disadvantage of a more frequent dose application and higher cost [ 70 ].…”

Platelet P2Y12 signalling pathway in the dysregulated immune response during sepsis

“…We also have a variety of P2Y 12 antagonists with different molecular structures and efficacy (Lam et al, 2021). For example, clopidogrel and prasugrel are administered through the oral route as pro‐drugs, so they require activation in the liver (Wongsalap et al, 2022), whereas ticagrelor is administered orally but not as a pro‐drug (Gurbel et al, 2010).…”

Review Artikel: Efikasi, Keamanan, Dan Durasi Penggunaan Antiplatelet Golongan P2y12 Inhibitor Pada Pasien Sindrom Koroner Akut

“…Studi cohort ini mengamati efikasi penggunaan DAPT antar kelompok aspirin dan clopidogrel, aspirin dan prasugrel, serta aspirin dan ticagrelor. Pada penelitian tersebut, dilaporkan bahwa kombinasi DAPT aspirin dan prasugrel/ticagrelor pada pengamatan 1-5 tahun dapat menurunkan kejadian MACE sebesar 40%, dan efek samping perdarahan yang lebih rendah dibandingkan dengan kelompok clopidogrel HR 0.46, 95% CI 0.21-1.00, p=0,051)(Lam, Yan and Lee, 2021). Selanjutnya, perbandingan studi klinis antiplatelet golongan P2Y12 Inhibitor akan dijelaskan pada Tabel 2.…”