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Ticagrelor versus clopidogrel in patients with acute coronary syndromes.

Publication ,  Journal Article
Wallentin, L; Becker, RC; Budaj, A; Cannon, CP; Emanuelsson, H; Held, C; Horrow, J; Husted, S; James, S; Katus, H; Mahaffey, KW; Scirica, BM ...
Published in: The New England journal of medicine
September 2009

Ticagrelor is an oral, reversible, direct-acting inhibitor of the adenosine diphosphate receptor P2Y12 that has a more rapid onset and more pronounced platelet inhibition than clopidogrel.In this multicenter, double-blind, randomized trial, we compared ticagrelor (180-mg loading dose, 90 mg twice daily thereafter) and clopidogrel (300-to-600-mg loading dose, 75 mg daily thereafter) for the prevention of cardiovascular events in 18,624 patients admitted to the hospital with an acute coronary syndrome, with or without ST-segment elevation.At 12 months, the primary end point--a composite of death from vascular causes, myocardial infarction, or stroke--had occurred in 9.8% of patients receiving ticagrelor as compared with 11.7% of those receiving clopidogrel (hazard ratio, 0.84; 95% confidence interval [CI], 0.77 to 0.92; P<0.001). Predefined hierarchical testing of secondary end points showed significant differences in the rates of other composite end points, as well as myocardial infarction alone (5.8% in the ticagrelor group vs. 6.9% in the clopidogrel group, P=0.005) and death from vascular causes (4.0% vs. 5.1%, P=0.001) but not stroke alone (1.5% vs. 1.3%, P=0.22). The rate of death from any cause was also reduced with ticagrelor (4.5%, vs. 5.9% with clopidogrel; P<0.001). No significant difference in the rates of major bleeding was found between the ticagrelor and clopidogrel groups (11.6% and 11.2%, respectively; P=0.43), but ticagrelor was associated with a higher rate of major bleeding not related to coronary-artery bypass grafting (4.5% vs. 3.8%, P=0.03), including more instances of fatal intracranial bleeding and fewer of fatal bleeding of other types.In patients who have an acute coronary syndrome with or without ST-segment elevation, treatment with ticagrelor as compared with clopidogrel significantly reduced the rate of death from vascular causes, myocardial infarction, or stroke without an increase in the rate of overall major bleeding but with an increase in the rate of non-procedure-related bleeding. (ClinicalTrials.gov number, NCT00391872.)

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Published In

The New England journal of medicine

DOI

EISSN

1533-4406

ISSN

0028-4793

Publication Date

September 2009

Volume

361

Issue

11

Start / End Page

1045 / 1057

Related Subject Headings

  • Ticlopidine
  • Ticagrelor
  • Stroke
  • Purinergic P2 Receptor Antagonists
  • Platelet Aggregation Inhibitors
  • Myocardial Infarction
  • Male
  • Kaplan-Meier Estimate
  • Humans
  • Hemorrhage
 

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Wallentin, L., Becker, R. C., Budaj, A., Cannon, C. P., Emanuelsson, H., Held, C., … Thorsén, M. (2009). Ticagrelor versus clopidogrel in patients with acute coronary syndromes. The New England Journal of Medicine, 361(11), 1045–1057. https://doi.org/10.1056/nejmoa0904327
Wallentin, Lars, Richard C. Becker, Andrzej Budaj, Christopher P. Cannon, Håkan Emanuelsson, Claes Held, Jay Horrow, et al. “Ticagrelor versus clopidogrel in patients with acute coronary syndromes.The New England Journal of Medicine 361, no. 11 (September 2009): 1045–57. https://doi.org/10.1056/nejmoa0904327.
Wallentin L, Becker RC, Budaj A, Cannon CP, Emanuelsson H, Held C, et al. Ticagrelor versus clopidogrel in patients with acute coronary syndromes. The New England journal of medicine. 2009 Sep;361(11):1045–57.
Wallentin, Lars, et al. “Ticagrelor versus clopidogrel in patients with acute coronary syndromes.The New England Journal of Medicine, vol. 361, no. 11, Sept. 2009, pp. 1045–57. Epmc, doi:10.1056/nejmoa0904327.
Wallentin L, Becker RC, Budaj A, Cannon CP, Emanuelsson H, Held C, Horrow J, Husted S, James S, Katus H, Mahaffey KW, Scirica BM, Skene A, Steg PG, Storey RF, Harrington RA, PLATO Investigators, Freij A, Thorsén M. Ticagrelor versus clopidogrel in patients with acute coronary syndromes. The New England journal of medicine. 2009 Sep;361(11):1045–1057.

Published In

The New England journal of medicine

DOI

EISSN

1533-4406

ISSN

0028-4793

Publication Date

September 2009

Volume

361

Issue

11

Start / End Page

1045 / 1057

Related Subject Headings

  • Ticlopidine
  • Ticagrelor
  • Stroke
  • Purinergic P2 Receptor Antagonists
  • Platelet Aggregation Inhibitors
  • Myocardial Infarction
  • Male
  • Kaplan-Meier Estimate
  • Humans
  • Hemorrhage