Reduction in First and Recurrent Cardiovascular Events With Ticagrelor Compared With Clopidogrel in the PLATO Study

Abstract

W hen analyzing the results of a large randomized, controlled trial, patients are typically censored from end point analysis after the first occurrence of any component of the composite primary end points. This practice limits information to clinicians on the effect of the randomized therapy on subsequent events. Even though information is collected about subsequent (eg, second, third, fourth, etc.) efficacy and safety end point events for the duration Background-We sought to evaluate the effect of potent platelet inhibition after acute coronary syndrome on total (ie, first and recurrent) occurrences of any of the primary outcome events (eg, cardiovascular death, myocardial infarction, and stroke) as well as on other ischemic events, such as urgent revascularization, (severe) recurrent ischemia, transient ischemic attacks, and arterial thrombotic events. Methods and Results-In the PLATelet inhibition and patient Outcomes (PLATO) study, 18 624 patients presenting with acute coronary syndromes randomly received ticagrelor (n=9333) or clopidogrel (n=9291). Cox proportional hazard models were used to calculate time to first event and hazard ratios.

Management of Acute Coronary Syndrome in the Hospital: A Focus on ACCF/AHA Guideline Updates to Oral Antiplatelet Therapy

“…After PCI, patients received prasugrel 10 mg/day or clopidogrel 75 mg/day for 6 to 15 months along with aspirin at a recommended daily dose of 75 to 162 mg throughout. 24 This trial demonstrated that prasugrel significantly reduced the occurrence of the primary end point (a composite of death from cardiovascular causes, nonfatal MI, or nonfatal stroke) by 19% compared with clopidogrel during a median 14.5 months of therapy (P , 0.001) 24 (Table 3 23,24,[27][28][29]. Prasugrel was also associated with a significantly lower rate of urgent target vessel revascularization (2.5% with prasugrel vs 3.7% with clopidogrel; P , 0.001), stent thrombosis (1.1% vs 2.4%; P , 0.001), and nonfatal MI (7.3% vs 9.5%; P , 0.001), but there was no significant difference between the groups in the rates of nonfatal stroke (1.0% in each group; P = 0.93) or death from cardiovascular causes (2.1% vs 2.4%; P = 0.31).…”

Competitive mode and site of interaction of ticagrelor at the human platelet P2Y12‐receptor

“…Superiority of ticagrelor over clopidogrel treatment in clinical outcomes of the PLATO (platelet inhibition and patient outcomes) trial was reported [9]. Besides evidence for clinical benefits when using ticagrelor, there is a controversial discussion about the molecular mode of interaction of ticagrelor with the P2Y 12 -receptor protein.…”

Antiplatelet Therapy Changes for Patients With Myocardial Infarction With Recurrent Ischemic Events: Insights Into Contemporary Practice From the TRANSLATE‐ACS (Treatment With ADP Receptor Inhibitors: Longitudinal Assessment of Treatment Patterns and Events After Acute Coronary Syndrome) Study

“…Bleeding risk is likely further exacerbated by extending antiplatelet treatment duration as a result of the recurrent ischemic event 22, 23. On‐treatment recurrent MI events were strongly associated with P2Y 12 inhibitor intensification both during the index MI hospitalization and postdischarge, presumably reflecting clinicians’ acceptance of the benefit of higher‐potency platelet inhibition in patients with recurrent MI 24. Surprisingly, shorter duration of time between the index and recurrent ischemic events was a predictor of P2Y 12 inhibitor intensification.…”