Efficacy and safety of ticagrelor versus clopidogrel in acute coronary syndrome in Taiwan: A multicenter retrospective pilot study

Chen, I‐Chih; Lee, Cheng‐Han; Fang, Ching-Chang; Chao, Ting‐Hsing; Cheng, Ching‐Lan; Chen, Yi; Yu, Ching-Lung; Lin, Chih‐Chan; Lin, Chun-Yuan; Li, Yi‐Heng

doi:10.1016/j.jcma.2016.02.010

Cited by 37 publications

(38 citation statements)

References 29 publications

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“…Only limited data exist on the comparison between the newer P2Y12 inhibitors (prasugrel and ticagrelor) and clopidogrel in East Asian patients with ACS. [20][21][22][23] The PHILO trial, which was designed to mirror PLATO, was a multicenter, randomized, double-blind, non-event-driven study conducted in Japan and East Asian countries (Japan, 90%; Taiwan, 4%). 21 The incidence of primary efficacy endpoints was 10.2% per year with ticagrelor and 8.1% per year with clopidogrel (HR, 1.47; 95% CI: 0.88-2.44).…”

Section: Discussionmentioning

confidence: 99%

Cardiovascular and Bleeding Risks in Acute Myocardial Infarction Newly Treated With Ticagrelor vs. Clopidogrel in Taiwan

Lee

Cheng

Yang

et al. 2018

Circ J

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Section: Discussionmentioning

confidence: 99%

Cardiovascular and Bleeding Risks in Acute Myocardial Infarction Newly Treated With Ticagrelor vs. Clopidogrel in Taiwan

Lee

Cheng

Yang

et al. 2018

Circ J

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“…A randomized trial[ 6 ] and meta-analysis[ 7 ] demonstrated that ticagrelor was no longer superior over clopidogrel in efficiency, with increased major bleeding. Whereas, two observational studies reported that ticagrelor offered significantly or marginally better anti-ischemic protection than clopidogrel in ACS[ 8 ] or AMI[ 9 ] patients, both without an increase in the rate of major bleeding. The above evidence implied that some critical factor might be closely involved in the efficacy of ticagrelor, which was special in East Asian patients and was changed when ticagrelor was applied from Phase III RCTs to the real-world clinical practice.…”

Section: Discussionmentioning

confidence: 99%

“…The most recent meta-analysis,[ 7 ] which focused on the population of East Asia, also demonstrated no advantage of ticagrelor on antithrombotic efficiency. Whereas, two recent real-world studies reported that ticagrelor could provide a marginally or significantly favorable antithrombotic efficacy in patients with ACS[ 8 ] or acute myocardial infarction (AMI),[ 9 ] both with similar major bleeding rates compared with clopidogrel. These contradictory results have caused considerable confusion regarding the efficacy of ticagrelor, providing the impetus to formulate better antiplatelet strategies.…”

Section: Introductionmentioning

confidence: 99%

Impact of Baseline Bleeding Risk on Efficacy and Safety of Ticagrelor versus Clopidogrel in Chinese Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention

Wang

et al. 2018

Chinese Medical Journal

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Background:There was still conflict on the antithrombotic advantage of ticagrelor versus clopidogrel among East Asian population with acute coronary syndrome (ACS). We considered that the baseline bleeding risk might be an undetected key factor that significantly affected the efficacy of ticagrelor.Methods:A total of 20,816 serial patients who underwent percutaneous coronary intervention (PCI) from October 2011 to August 2014 in the General Hospital of Shenyang Military Region were enrolled in the present study. Patients receiving ticagrelor or clopidogrel were further subdivided according to basic bleeding risk. The primary outcome was net adverse clinical events (NACEs) defined as major adverse cardiac or cerebral events (MACCE, including all-cause death, myocardial infarction, ischemia-driven target vessel revascularization, or stroke) and any bleeding during 1-year follow-up. Comparison between ticagrelor and clopidogrel was adjusted by propensity score matching (PSM).Results:Among the 20,816 eligible PCI patients who were included in this study, there were 1578 and 779 patients in the clopidogrel and ticagrelor groups, respectively, after PSM, their clinical parameters were well matched. Patients receiving ticagrelor showed comparable NACE risk compared with those treated by clopidogrel (5.3% vs. 5.1%, P = 0.842). Furthermore, ticagrelor might reduce the MACCE risk in patients with low bleeding risk but increase MACCE in patients with moderate-to-high bleeding potential (ticagrelor vs. clopidogrel, low bleeding risk: 2.5% vs. 4.9%, P = 0.022; moderate-to-high bleeding risk: 4.8% vs. 3.0%, P = 0.225; interaction P = 0.021), with vast differences in all bleeding (low bleeding risk: 1.5% vs. 0.8%, P = 0.210; moderate-to-high bleeding risk: 4.8% vs. 3.0%, P = 0.002; interaction P = 0.296).Conclusion:Among real-world Chinese patients with ACS treated by PCI, ticagrelor only showed superior efficacy in patients with low bleeding risk but lost its advantage in patients with moderate-to-high bleeding potential.

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“…Moreover, recent studies indicated that ticagrelor was no longer superior over clopidogrel in efficacy and was associated with increased bleeding risk 16,28 . These studies implied that East Asian patients may have different features that influence the response to antiplatelet agents and related clinical outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…Although the presence of MVD has been associated with an elevated risk of high platelet reactivity (HPR) after clopidogrel treatment 18 and a higher hazard of MACE, 30 no studies have investigated the role of MVD on the relative efficacies of antiplatelet therapies. Previous studies comparing different antiplatelet therapies have examined potential effect modifiers by subgroup analysis, that is calculating the HR conditioning on a third clinical variable (such as age, sex, and comorbidities) 16,28 . However, the set of stratification variables in the subgroup analyses were selected a priori, and some potential effect modifiers beyond the current knowledge—such as the number of diseased vessels—may thus have been left unexamined.…”

Section: Discussionmentioning

confidence: 99%

Efficacy assessment of ticagrelor versus clopidogrel in Chinese patients with acute coronary syndrome undergoing percutaneous coronary intervention by data mining and machine‐learning decision tree approaches

Xue

Jing

et al. 2020

J Clin Pharm Ther

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What is known and Objective Although ticagrelor has been well‐known to improve clinical outcomes in patients undergoing percutaneous coronary intervention (PCI), and its effectiveness and safety have not been well evaluated in Chinese patients. This study aimed to evaluate the effectiveness and safety of ticagrelor in Chinese patients. In order to find potential effect modifiers on the drug effects, a decision tree method was performed to detect interactions between treatment and patient characteristics in an automatic and systematic manner. Methods This retrospective study included acute coronary syndrome (ACS) patients who underwent PCI and received either ticagrelor (N = 250) or clopidogrel (N = 291) while hospitalized between August 2014 and August 2015. After propensity score matching, Kaplan‐Meier analysis was used to study the event‐free survival against major adverse cardiovascular events (MACE, primary efficacy outcome, defined as the composite of cardiac death, non‐fatal myocardial infarction [MI], stroke, restenosis and target vessel revascularization [TVR]), re‐hospitalization, the need for urgent re‐PCI (secondary efficacy outcome) and bleeding events (safety outcome) within 12 months of the PCI date. To search for effect modifiers of the two antiplatelet therapies, a machine‐learning decision tree algorithm was conducted to predict re‐hospitalization status. Results After propensity score matching (N = 442), ticagrelor and clopidogrel had no significant difference in MACE, re‐hospitalization and bleeding. The decision tree analysis showed that the number of diseased vessels modulated the effect of ticagrelor and clopidogrel on re‐hospitalization rates. In single‐vessel disease (SVD) patients, ticagrelor was associated with lower hazards than clopidogrel for all efficacy outcomes: MACE (HR = 0.190, 95% CI: 0.042–0.866), re‐hospitalization (HR = 0.296, 95% CI: 0.108–0.808), urgent re‐PCI (HR = 0.249, 95% CI: 0.069–0.895), bleeding (HR = 1.006, 95% CI: 0.063–16.129). However, in multi‐vessel disease (MVD) patients, the two treatments did not show significant difference. What is New and Conclusion In the general patient population, there was no significant difference between ticagrelor and clopidogrel on the hazard of MACE. However, ticagrelor achieved a better effectiveness than clopidogrel in patients with SVD. This pilot study provides scientific basis to call for a large‐scale prospective study in this population.

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Efficacy and safety of ticagrelor versus clopidogrel in acute coronary syndrome in Taiwan: A multicenter retrospective pilot study

Abstract: Ticagrelor treatment could provide a marginally favorable effect at the expense of an increased risk of dyspnea in real-life situations. This pilot study provides a scientific basis to call for a larger, suitably powered Phase 4 prospective or observational study in this ethnic population.

Cited by 37 publications

References 29 publications

Cardiovascular and Bleeding Risks in Acute Myocardial Infarction Newly Treated With Ticagrelor vs. Clopidogrel in Taiwan

Cardiovascular and Bleeding Risks in Acute Myocardial Infarction Newly Treated With Ticagrelor vs. Clopidogrel in Taiwan

Impact of Baseline Bleeding Risk on Efficacy and Safety of Ticagrelor versus Clopidogrel in Chinese Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention

Efficacy assessment of ticagrelor versus clopidogrel in Chinese patients with acute coronary syndrome undergoing percutaneous coronary intervention by data mining and machine‐learning decision tree approaches

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