Ticagrelor Versus Clopidogrel in Patients With Acute Coronary Syndromes and a History of Stroke or Transient Ischemic Attack
| Contribuinte(s) |
UNIVERSIDADE DE SÃO PAULO |
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| Data(s) |
05/11/2013
05/11/2013
2012
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| Resumo |
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. AstraZeneca AstraZeneca Eli Lilly Eli Lilly Merck Merck BristolMyers Squibb Bristol-Myers Squibb Eli Lilly/Daiichi Sankyo Eli Lilly/Daiichi Sankyo Accumetrics Accumetrics Dynabyte Dynabyte Novartis Novartis Eisai Eisai Bayer Bayer Boehringer Ingelheim Boehringer Ingelheim GlaxoSmithKline GlaxoSmithKline Johnson and Johnson Johnson and Johnson Ortho/McNeill Ortho/McNeill Sanofi-aventis SanofiAventis Daiichi Sankyo Daiichi Sankyo Portola Pharmaceuticals Portola Pharmaceuticals Pozen Pozen Regado Biosciences Regado Biosciences Medicines Company Medicines Company MSD MSD Jaba Recordati Jaba Recordati Pfizer Pfizer |
| Identificador |
CIRCULATION, PHILADELPHIA, v. 125, n. 23, supl. 1, Part 3, pp. 2914-+, 41061, 2012 0009-7322 http://www.producao.usp.br/handle/BDPI/41341 10.1161/CIRCULATIONAHA.111.082727 |
| Idioma(s) |
eng |
| Publicador |
LIPPINCOTT WILLIAMS & WILKINS PHILADELPHIA |
| Relação |
CIRCULATION |
| Direitos |
closedAccess Copyright LIPPINCOTT WILLIAMS & WILKINS |
| Palavras-Chave | #ACUTE CORONARY SYNDROME #ANTIPLATELET DRUGS #CARDIOVASCULAR DISEASES #STROKE #TICAGRELOR #THROMBIN-RECEPTOR ANTAGONIST #PERIPHERAL ARTERIAL-DISEASE #OUTCOMES PLATO TRIAL #ST-SEGMENT-ELEVATION #MYOCARDIAL-INFARCTION #PLATELET INHIBITION #ASPIRIN #EVENTS #PREVENTION #RATIONALE #CARDIAC & CARDIOVASCULAR SYSTEMS #PERIPHERAL VASCULAR DISEASE |
| Tipo |
article original article publishedVersion |
