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Ticagrelor versus clopidogrel in patients with acute coronary syndromes and a history of stroke or transient ischemic attack.

Publication ,  Journal Article
James, SK; Storey, RF; Khurmi, NS; Husted, S; Keltai, M; Mahaffey, KW; Maya, J; Morais, J; Lopes, RD; Nicolau, JC; Pais, P; Raev, D ...
Published in: Circulation
June 12, 2012

BACKGROUND: Patients with acute coronary syndromes and history of stroke or transient ischemic attack (TIA) have an increased rate of recurrent cardiac events and intracranial hemorrhages. METHODS AND RESULTS: We evaluated treatment effects of ticagrelor versus clopidogrel in patients with acute coronary syndrome with and without a history of prior stroke or TIA in the PLATelet inhibition and patient Outcomes (PLATO) trial. Of the 18 624 randomized patients, 1152 (6.2%) had a history of stroke or TIA. Such patients had higher rates of myocardial infarction (11.5% versus 6.0%), death (10.5% versus 4.9%), stroke (3.4% versus 1.2%), and intracranial bleeding (0.8% versus 0.2%) than patients without prior stroke or TIA. Among patients with a history of stroke or TIA, the reduction of the primary composite outcome and total mortality at 1 year with ticagrelor versus clopidogrel was consistent with the overall trial results: 19.0% versus 20.8% (hazard ratio, 0.87; 95% confidence interval, 0.66-1.13; interaction P=0.84) and 7.9% versus 13.0% (hazard ratio, 0.62; 95% confidence interval, 0.42-0.91). The overall PLATO-defined bleeding rates were similar: 14.6% versus 14.9% (hazard ratio, 0.99; 95% confidence interval, 0.71-1.37), and intracranial bleeding occurred infrequently (4 versus 4 cases, respectively). CONCLUSIONS: Patients with acute coronary syndrome with a prior history of ischemic stroke or TIA had higher rates of clinical outcomes than patients without prior stroke or TIA. However, the efficacy and bleeding results of ticagrelor in these high-risk patients were consistent with the overall trial population, with a favorable clinical net benefit and associated impact on mortality. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicatrials.gov. Unique identifier: NCT00391872.

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Published In

Circulation

DOI

EISSN

1524-4539

Publication Date

June 12, 2012

Volume

125

Issue

23

Start / End Page

2914 / 2921

Location

United States

Related Subject Headings

  • Ticlopidine
  • Ticagrelor
  • Stroke
  • Risk Factors
  • Purinergic P2Y Receptor Antagonists
  • Myocardial Infarction
  • Middle Aged
  • Male
  • Ischemic Attack, Transient
  • Intracranial Hemorrhages
 

Citation

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James, S. K., Storey, R. F., Khurmi, N. S., Husted, S., Keltai, M., Mahaffey, K. W., … PLATO Study Group. (2012). Ticagrelor versus clopidogrel in patients with acute coronary syndromes and a history of stroke or transient ischemic attack. Circulation, 125(23), 2914–2921. https://doi.org/10.1161/CIRCULATIONAHA.111.082727
James, Stefan K., Robert F. Storey, Nardev S. Khurmi, Steen Husted, Matyas Keltai, Kenneth W. Mahaffey, Juan Maya, et al. “Ticagrelor versus clopidogrel in patients with acute coronary syndromes and a history of stroke or transient ischemic attack.Circulation 125, no. 23 (June 12, 2012): 2914–21. https://doi.org/10.1161/CIRCULATIONAHA.111.082727.
James SK, Storey RF, Khurmi NS, Husted S, Keltai M, Mahaffey KW, et al. Ticagrelor versus clopidogrel in patients with acute coronary syndromes and a history of stroke or transient ischemic attack. Circulation. 2012 Jun 12;125(23):2914–21.
James, Stefan K., et al. “Ticagrelor versus clopidogrel in patients with acute coronary syndromes and a history of stroke or transient ischemic attack.Circulation, vol. 125, no. 23, June 2012, pp. 2914–21. Pubmed, doi:10.1161/CIRCULATIONAHA.111.082727.
James SK, Storey RF, Khurmi NS, Husted S, Keltai M, Mahaffey KW, Maya J, Morais J, Lopes RD, Nicolau JC, Pais P, Raev D, Lopez-Sendon JL, Stevens SR, Becker RC, PLATO Study Group. Ticagrelor versus clopidogrel in patients with acute coronary syndromes and a history of stroke or transient ischemic attack. Circulation. 2012 Jun 12;125(23):2914–2921.

Published In

Circulation

DOI

EISSN

1524-4539

Publication Date

June 12, 2012

Volume

125

Issue

23

Start / End Page

2914 / 2921

Location

United States

Related Subject Headings

  • Ticlopidine
  • Ticagrelor
  • Stroke
  • Risk Factors
  • Purinergic P2Y Receptor Antagonists
  • Myocardial Infarction
  • Middle Aged
  • Male
  • Ischemic Attack, Transient
  • Intracranial Hemorrhages