Ticagrelor Versus Clopidogrel in Patients With STEMI Treated With Fibrinolysis

COVID‐19 pandemic: Challenges and solutions from the cardiology pharmacist's perspective

“…7,8,10 In the TREAT trial, STEMI patients less than 75 years of age who received thrombolytics were primarily pretreated with clopidogrel and could be transitioned to ticagrelor with a recommended 180 mg loading dose within 24 hours of randomization. 9 The rates of intracranial hemorrhage in this study were similar between groups. In the TRITON-TIMI-38 trial, patients who received thrombolytics were excluded from the trial, thus limited data on T A B L E 1 Summary of the concomitant medications administered with thrombolytics for ST-elevation myocardial infarction (STEMI) suggest alternative therapies.…”

“…Studies have demonstrated the risk of intracranial hemorrhage with thrombolytics is less than 1%. [7][8][9][10] One anticoagulant consideration, for a patient with COVID-19, is the nursing time spent in the room monitoring and adjusting UFH vs the ease of giving subcutaneous enoxaparin. For both agents, anticoagulation is started 15 minutes before to 30 minutes after the initiation of thrombolytic therapy.…”

Major Cardiovascular Advances: Highlights from the 2019 American College of Cardiology Annual Scientific Session

“…According to Berwanger et al, at 12 months there was a non-significant reduction in time to first major bleeding events in patients who Annual Meetings received ticagrelor (6.7%) compared with (7.3%) in patients who received clopidogrel. 15 In terms of safety, there were no differences in the rates of major, fatal, and intracranial bleeding between ticagrelor and clopidogrel following fibrinolytic therapy in patients with STEMI. The results of this trial might expand the indications of ticagrelor to include individuals with STEMI treated with fibrinolytic therapy.…”

“…The Ticagrelor in Patients with ST Elevation Myocardial Infarction Treated with Pharmacological Thrombolysis (TREAT) trial compared the efficacy and safety of ticagrelor versus clopidogrel in patients with ST-segment elevation MI (STEMI) who were treated with fibrinolytic therapy. 15 A total of 3,799 patients aged <75 years were randomized to receive either ticagrelor (180 mg loading dose followed by 90 mg twice daily) or clopidogrel (300-600 mg loading dose followed by 75 mg per day). The primary outcome was time to first major bleeding event (thrombolysis in MI).…”

Congress of the American College of Cardiology (New Orleans, 2019): Clinical Findings

“…Ранее сообщалось, что в среднем через 11 ч после фибринолиза у больных с ИМ и стойким подъемом сегмента ST применение тикагрелора (n=1913) не уступает использованию клопидогрела (n=1886) в отношении риска больших, внутричерепных и смертельных кровотечений в течение 30 дней [3]. Наблюдение за пациентами, включенными в исследование TREAT (TicagRElor in PATients With ST-Elevation Myocardial Infarction Treated With Pharmacological Thrombolysis), было продолжено до 12 мес., в течение которых смерть от сердечнососудистых заболеваний, ИМ, инсульт/транзиторная ишемическая атака, рецидивирующая ишемия или другие артериальные тромботические события регистрировались в 8,0% в группе тикагрелора vs 9,1% в группе клопидогрела (р=0,25) [4]. Полученные данные позволили авторам проекта констатировать равные безопасность и эффективность тикагрелора и клопидогрела у пациентов моложе 75 лет с ИМ и стойким подъемом сегмента ST при проведении фибринолитической терапии.…”