Net Adverse Clinical Events With Antiplatelet Therapy in Acute Coronary Syndromes

Clopidogrel, prasugrel, and ticagrelor are oral platelet P2Y12 receptor inhibitors that decrease the risk of platelet-mediated coronary artery thrombosis. Clinical guidelines have recommended ticagrelor or prasugrel over clopidogrel in combination with aspirin as dual antiplatelet therapy (DAPT) for 1 year after acute coronary syndrome (ACS), whether or not percutaneous coronary intervention (PCI) is performed. The ticagrelor recommendation was based on the Study of Platelet Inhibition and Patient Outcomes (PLATO) trial, which enrolled 18  624 patients with ACS and randomized them to receive DAPT with either clopidogrel and aspirin or ticagrelor and aspirin. The 1-year primary composite efficacy end point of death from vascular causes, myocardial infarction (MI), or stroke favored ticagrelor and aspirn vs clopidogrel and aspirin (9 .8% vs 11.7%; hazard ratio, 0.84 [95% CI, 0.77-0.92]; P <  .001), but major bleeding not related to coronary artery bypass graft surgery was increased with ticagrelor and aspirin vs clopidogrel and aspirin (4.5% vs 3.8%; P = .03).
Source: JAMA - Category: General Medicine Source Type: research