The platform will undergo maintenance on Sep 14 at about 7:45 AM EST and will be unavailable for approximately 2 hours.

Journal of the American College of Cardiology

2019

DOI: 10.1016/j.jacc.2019.03.470

|View full text |Cite

|

Sign up to set email alerts

|

Premature Ticagrelor Discontinuation in Secondary Prevention of Atherosclerotic CVD

¹

,

²

,

Muthiah Vaduganathan

³

et al.

Help me understand this report

Search citation statements

Order By: Relevance

Paper Sections

Select...

Introduction2

Methods1

Discussion1

Organisation (Year) Recommendation1

Citation Types

Supporting

2

Mentioning

56

Contrasting

0

Unclassified

1

Year Published

2019

2019

2024

2024

Publication Types

Select...

Article9

Relationship

Self Cite0

Independent9

Authors

Journals

Cited by 51 publications

(59 citation statements)

References 59 publications

Supporting

2

Mentioning

56

Contrasting

0

Unclassified

1

Order By: Relevance

“… 19 Probabilities on clopidogrel treatment could not be obtained from the CAPRIE trial but were informed relative to those of ticagrelor DPI. 16 , 20 Scenarios explore alternative bleeding risks. 21 …”

Section: Methodsmentioning

confidence: 99%

Rivaroxaban plus aspirin for the prevention of ischaemic events in patients with cardiovascular disease: a cost-effectiveness study

¹

,

²

,

³

et al. 2020

European Journal of Preventive Cardiology

View full text Add to dashboard Cite

Background Dual pathway inhibition with 2.5 mg rivaroxaban twice daily plus 100 mg aspirin once daily may be a promising alternative to 100 mg aspirin antiplatelet therapy for the prevention of cardiovascular events in patients with coronary artery disease and/or peripheral arterial disease. However, treatment costs and bleeding risks are higher, and there is another treatment option for peripheral arterial disease, 75 mg clopidogrel. A comprehensive assessment of benefits, risks and costs of dual pathway inhibition versus standard of care is needed. Methods We used a state transition model including cardiovascular, ischaemic limb and bleeding events to compare dual pathway inhibition to aspirin antiplatelet therapy in coronary artery disease, and additionally to clopidogrel antiplatelet therapy in peripheral arterial disease patients. We calculated the incremental cost-effectiveness ratio from costs and quality-adjusted life-years of lifelong treatment, and the cost-effectiveness probability at a €50,000/quality-adjusted life-year threshold. Results Quality-adjusted life-years and costs of dual pathway inhibition were highest, the incremental cost-effectiveness ratios versus aspirin were €32,109 in coronary artery disease and €26,381 in peripheral arterial disease patients, with 92% and 56% cost-effectiveness probability, respectively (clopidogrel was extendedly dominated). Incremental cost-effectiveness ratios were below €20,000 in comorbid peripheral arterial disease patients and coronary artery disease patients younger than 65 years, incremental cost-effectiveness ratios were above €50,000 in carotid artery disease patients and coronary artery disease patients older than 75 years. Conclusion Lifelong preventive treatment of coronary artery disease and peripheral arterial disease patients at risk of cardiovascular events with dual pathway inhibition improves health outcomes and seems overall cost-effective relative to aspirin antiplatelet therapy and also to clopidogrel antiplatelet therapy for peripheral arterial disease, particularly in comorbid patients, but not in older patients and in carotid artery disease patients. These findings may warrant a targeted approach.

“… 19 Probabilities on clopidogrel treatment could not be obtained from the CAPRIE trial but were informed relative to those of ticagrelor DPI. 16 , 20 Scenarios explore alternative bleeding risks. 21 …”

Section: Methodsmentioning

confidence: 99%

Rivaroxaban plus aspirin for the prevention of ischaemic events in patients with cardiovascular disease: a cost-effectiveness study

¹

,

²

,

³

et al. 2020

European Journal of Preventive Cardiology

View full text Add to dashboard Cite

Background Dual pathway inhibition with 2.5 mg rivaroxaban twice daily plus 100 mg aspirin once daily may be a promising alternative to 100 mg aspirin antiplatelet therapy for the prevention of cardiovascular events in patients with coronary artery disease and/or peripheral arterial disease. However, treatment costs and bleeding risks are higher, and there is another treatment option for peripheral arterial disease, 75 mg clopidogrel. A comprehensive assessment of benefits, risks and costs of dual pathway inhibition versus standard of care is needed. Methods We used a state transition model including cardiovascular, ischaemic limb and bleeding events to compare dual pathway inhibition to aspirin antiplatelet therapy in coronary artery disease, and additionally to clopidogrel antiplatelet therapy in peripheral arterial disease patients. We calculated the incremental cost-effectiveness ratio from costs and quality-adjusted life-years of lifelong treatment, and the cost-effectiveness probability at a €50,000/quality-adjusted life-year threshold. Results Quality-adjusted life-years and costs of dual pathway inhibition were highest, the incremental cost-effectiveness ratios versus aspirin were €32,109 in coronary artery disease and €26,381 in peripheral arterial disease patients, with 92% and 56% cost-effectiveness probability, respectively (clopidogrel was extendedly dominated). Incremental cost-effectiveness ratios were below €20,000 in comorbid peripheral arterial disease patients and coronary artery disease patients younger than 65 years, incremental cost-effectiveness ratios were above €50,000 in carotid artery disease patients and coronary artery disease patients older than 75 years. Conclusion Lifelong preventive treatment of coronary artery disease and peripheral arterial disease patients at risk of cardiovascular events with dual pathway inhibition improves health outcomes and seems overall cost-effective relative to aspirin antiplatelet therapy and also to clopidogrel antiplatelet therapy for peripheral arterial disease, particularly in comorbid patients, but not in older patients and in carotid artery disease patients. These findings may warrant a targeted approach.

“…They restricted patients' functioning, were very poorly tolerated and were threat to their lives, hence our decision to switch the treatment. 1,2,34 There are a few groups of patients that we should be especially careful with. These are patients suffering from COPD, asthma, AV blocks and significantly decreased EF.…”

Section: Discussionmentioning

confidence: 99%

“…We show how to conduct differential diagnostics, how to treat the patients and finally we discuss the 2 main hypotheses concerning these side effects. 1,2…”

Section: Introductionmentioning

confidence: 99%

Ticagrelor-Related Severe Dyspnoea: Mechanisms, Characteristic Features, Differential Diagnosis and Treatment

¹

,

²

,

³

et al. 2020

Clin Med Insights Case Rep

View full text Add to dashboard Cite

With a growing number of patients on ticagrelor therapy after stent implantation, we observe many cases of side effects of the drug, mostly dyspnoea and bradycardia. In our article we present 2 patients, in which the symptoms were particularly severe. Then we describe possible mechanisms of these complications, explain how to carry out differential diagnosis, discuss when to switch ticagrelor to other antiplatelet drug and finally we present the way to deal with the symptoms.

“…3 Given the high residual thrombotic risk even with optimised DAPT, compliance is crucial in DM patients, because large observational studies including DM patients showed that interrupting either the P2Y 12 inhibitor or aspirin from DAPT, particularly in the first 6 months, is associated with significantly worse outcomes. 38,39 A large observational study, 40 a metaanalysis of RCTs that enrolled between 25% and 38% of DM patients, 41 and a recent trial in DM, 32 showed that 25-35% of patients prematurely interrupt ticagrelor. Dyspnoea, a ticagrelor-specific adverse effect, accounts for approximately equal to 50% of discontinuation (HR 6.40, 95% CI 5.39-7.41 versus comparators in RCT).…”

Section: Organisation (Year) Recommendationmentioning

confidence: 99%

Antithrombotic therapy and revascularisation strategies in people with diabetes and coronary artery disease

²

,

2019

Eur J Prev Cardiolog

View full text Add to dashboard Cite

Background Diabetes mellitus, largely type 2, affects nearly 10% of the global adult population according to the World Health Organization. Diabetes is an independent risk factor for atherosclerotic cardiovascular diseases, including coronary artery disease. Diabetes patients experience a two to three-fold increased incidence of coronary artery disease, despite improved metabolic control and management of other cardiovascular risk factors. Discussion Platelet abnormalities and activation as well as reduced antiplatelet drug responsiveness characterise diabetes mellitus. Mechanisms linking diabetes to platelet and vascular abnormalities, atherogenesis and atherosclerotic cardiovascular disease are still only partially known, highlighting the unique complexity of the pro-atherogenic clinical scenario and its treatment. Consistently, a higher residual cardiovascular risk characterises patients with diabetes compared with those without, in spite of improved antiplatelet and antithrombotic treatment combinations. Randomised clinical trials aimed at optimising antiplatelet treatment specifically in patients with diabetes are lacking, both in acute and chronic coronary artery disease settings. Thus, patients with diabetes are treated with regimens validated in studies including only variable proportions of diabetes patients. Myocardial revascularisation appears to confer a comparable relative benefit between diabetes patients and patients without diabetes, and generally coronary artery bypass grafting has a better outcome in diabetes mellitus versus peripheral coronary intervention. New glucose-lowering drugs have been shown to reduce the incidence of major cardiovascular events in secondary prevention. Type 1 diabetes mellitus remains less explored than type 2 in this context. Conclusion Diabetes-tailored antithrombotic strategies in acute and chronic coronary artery disease remain an unmet clinical need, requiring ad-hoc trials and precision pharmacological strategies.

scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.

Contact Info

hi@scite.ai

10624 S. Eastern Ave., Ste. A-614

Henderson, NV 89052, USA

Product

Browser Extension Assistant by scite Citation Statement Search Reference Check Visualizations Dashboards Explore Journals Explore Organizations Explore Funders Embedding Badge Embedding Citation Search Pricing

Resources

Blog Help & FAQ Accessibility Statement API Terms For Universities & Governments For Researchers For Publishers For Corporate, Pharma & Enterprise Author Marketing Become an Affiliate Get an organization trial or quote scite Data & Services

About

News & Press Careers Read our Paper Coverage

Blog Terms and Conditions API Terms Privacy Policy Contact Cookie Preferences Do Not Sell or Share My Personal Information

Copyright © 2024 scite LLC. All rights reserved.

Made with 💙 for researchers

Part of the Research Solutions Family.