scholarly journals Efficacy and safety of low dose ticagrelor in patients with acute coronary syndrome: a systematic review and meta-analysis

2020 ◽  
Vol 96 (1141) ◽  
pp. 693-702
Author(s):  
Qing Chen ◽  
Yuanyuan Zhang ◽  
Zhen Wang ◽  
Shuai Wang ◽  
Hao Zhang ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Platelet Aggregation ◽  
Major Bleeding ◽  
Low Dose ◽  
Standard Dose ◽  
Left Ventricular ◽  
Efficacy And Safety ◽  
Bleeding Events ◽  
Coronary Syndrome ◽  
Major Bleeding Events

Our aim was to examine clinical trials, provide guidance to practitioners and estimate the efficacy and safety of two agents by comparing low dose ticagrelor with standard dose clopidogrel in patients with acute coronary syndrome. We systematically looked through Pubmed, Embase, the Cochrane Library, Wanfang data and CNKI for trials comparing low dose ticagrelor with standard dose clopidogrel for the treatment of patients with ACS since the database was created. The primary endpoint for efficacy was the rate of major adverse cardiac events (MACEs). The primary endpoint for safety was the rate of major bleeding events. We also evaluated platelet function between low dose ticagrelor and standard dose clopidogrel in ACS patients. From 6744 articles, 16 studies including 1629 patients met the inclusion criteria. In contrast with standard dose clopidogrel, low dose ticagrelor significantly reduced MACEs (OR 0.39, 95% CI 0.26, 0.58) and the difference was statistically significant (p<0.01). No difference was noted for major bleeding events (OR 1.16, 95% CI 0.43, 3.08) between the two agents (p=0.77). In addition, low dose ticagrelor showed lower platelet aggregation rate than clopidogrel (standardised mean difference (SMD) −0.68, 95% CI −0.83 to 0.53) (p<0.01). Platelet reaction units for low dose ticagrelor were much lower than those for standard dose clopidogrel (SMD −2.46, 95% CI −2.85 to −2.07) (p<0.01). In comparison with standard dose clopidogrel, low dose ticagrelor significantly lowered the incidence of MACEs, improved left ventricular ejection fraction, decreased left ventricular end diastolic dimension and did not expand the risk of major bleeding events or minor or minimal bleeding events in ACS patients with a considerable safety and efficacy profile. In addition, low dose ticagrelor was associated with dramatically lower platelet aggregation compared with standard dose clopidogrel.

scholarly journals Cardiovascular outcomes of clopidogrel and aspirin vs ticagrelor and aspirin in geriatric population with acute coronary syndrome-a systematic review and meta analysis

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
A Abdul Razzack ◽  
S Pothuru ◽  
N Hussain ◽  
S Adeel Hassan ◽  
P Panday ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
High Risk ◽  
Major Bleeding ◽  
Efficacy And Safety ◽  
Bleeding Events ◽  
Geriatric Population ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment ◽  
Major Bleeding Events

Abstract Funding Acknowledgements Type of funding sources: None. Background The current guidelines of the European Society of Cardiology recommends dual antiplatelet treatment (DAPT) including a  new-generation P2Y12-inhibitor ticagrelor and aspirin for patients with acute coronary syndrome (ACS) with or without ST segment elevation (STEMI). However, the efficacy and safety profile of standard DAPT regimen clopidogrel and aspirin (CDAPT) vs. new DAPT regiment ticagrelor and aspirin (TDAPT) is controversial in geriatric population with age &gt;70 years given this population is a high risk for bleeding due to frailty and recurrent of ACS. Objective   To assess the efficacy and safety of DAPT regimens including CDAPT or TDAPT  for elderly patients &gt;70 years presenting with ACS with or without ST-segment elevation.  Methods Electronic databases (PubMed, Embase, Scopus, Cochrane) were searched from inception to November 28th, 2020. Using a generic invariance weighted fixed effects model, Hazard ratios (HRs) and their 95% confidence intervals (CIs) from individual studies were converted to Log HRs and corresponding standard errors, which were then pooled. The primary outcome was major adverse cardiac and cerebrovascular events (MACCE)and was defined as a composite of death, myocardial reinfarction and stroke. The secondary outcome was any major bleeding events.  Results- A total of four studies with 18365 participants was included in our analysis.Mean age was 79.4 and 79.2 in the CDAPT and TDAPT groups respectively.  Average follow up period was 12 months. There is no difference in MACCE among CDAPT and TDAPT( HR 0.93, 95%CI 0.86-1.01;P = 0.10). However, TDAPT is associated with high risk of major bleeding as compared to CDAPT (HR 1.15, 95%CI 1.02-1.29; P = 0.02) (Figure 1). We had no publication bias in our results (Egger’s regression p &gt; 0.05). Conclusion- Amongst geriatric patients aged 70 years or older with ACS with or without STEMI, TDAPT has the same MACCE as compared to CDAPT while TDAPT can have high major bleeding. Abstract Figure. A)MACCE B)Major Bleeding events

scholarly journals Ischemic and Bleeding Events Among Patients With Acute Coronary Syndrome Associated With Low-Dose Prasugrel vs Standard-Dose Clopidogrel Treatment

2020 ◽  
Vol 3 (4) ◽  
pp. e202004 ◽  
Author(s):  
Satoshi Shoji ◽  
Mitsuaki Sawano ◽  
Alexander T. Sandhu ◽  
Paul A. Heidenreich ◽  
Yasuyuki Shiraishi ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Low Dose ◽  
Standard Dose ◽  
Bleeding Events ◽  
Coronary Syndrome

A Randomized Non-Inferiority Study of Low-dose and Standard-dose Ticagrelor After Intervention for Acute Coronary Syndrome : Study Protocol for the TIGER STUDY

2021 ◽  
Author(s):  
Yanan Pang ◽  
Minglu Ma ◽  
Dong Wang ◽  
Hongyi Wu ◽  
Wei Hu ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Low Dose ◽  
Dual Antiplatelet Therapy ◽  
Standard Dose ◽  
Academic Research ◽  
Bleeding Events ◽  
Coronary Syndrome ◽  
Risk Of Bleeding ◽  
Research Consortium ◽  
Ischemic Events

Abstract BackgroundCurrent guidelines recommend that patients with acute coronary syndrome (ACS) who have successfully undergone percutaneous coronary intervention (PCI) should continue to use dual antiplatelet therapy (DAPT) for 12 months. The long-term use of standard-dose dual antiplatelet therapy will increase the risk of bleeding. An optimized antiplatelet strategy that can prevent ischemic events and reduce the risk of bleeding remains to be explored.MethodsThe study is a prospective, multicenter, randomized, open-label, controlled study involving 2120 patients from six clinical centers in China. Through the Interactive Web Response System (IWRS), ACS patients undergoing successful PCI will be randomly divided into the low-dose ticagrelor group or the normal-dose ticagrelor group, after taking 100 mg aspirin and 90 mg ticagrelor bid for 1 week. The primary endpoint is a composite of cardiovascular death, non-fatal myocardial infarction, stent thrombosis, repeat revascularization, stroke, and bleeding events of grade 2 or higher according to Bleeding Academic Research Consortium [BARC] criteria at one year. The secondary endpoints are bleeding events of grade 2 or higher according to Bleeding Academic Research Consortium [BARC] criteria at one year.DiscussionRecent studies have confirmed that 90 mg ticagrelor alone can safely and effectively reduce bleeding without increasing ischemic events of patients with ACS after PCI. Compared with standard-dose DAPT, whether low-dose ticagrelor combined with aspirin can ensure the anti-ischemic effect while reducing the bleeding risk remains unclear in Chinese patients.The Tiger study will be the first large-scale, multicenter study to compare the efficacy and safety of low-dose and standard-dose ticagrelor combined with aspirin in ACS patients one week after successful PCI.Trial registrationClinicaltrials.gov, NCT04255602. Registered on 5 February 2020.

scholarly journals Ticagrelor monotherapy versus dual anti-platelet therapy in patients undergoing percutaneous coronary intervention: a subgroup analysis of safety in multiple comorbidities

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
M M Patel ◽  
K Zerihun
Keyword(s):  
Acute Coronary Syndrome ◽  
Major Bleeding ◽  
Subgroup Analysis ◽  
Coronary Intervention ◽  
The Elderly ◽  
Bleeding Events ◽  
Coronary Syndrome ◽  
Cerebrovascular Events ◽  
Major Bleeding Events ◽  
Post Hoc

Abstract Background The TICO trial evaluated the effectiveness of ticagrelor monotherapy after 3 months of dual antiplatelet therapy (DAPT) versus continued DAPT and measured the risk of major bleeding and adverse cardiac/cerebrovascular events at 12 months, however there are certain subgroups such as the elderly that have higher bleeding risks than the average population. Objective To determine if specific comorbidities or patient demographics increase the risks of major bleeding or major cardiac/cerebrovascular events in patients receiving ticagrelor monotherapy versus aspirin plus ticagrelor in patients post percutaneous coronary intervention with acute coronary syndrome. Methods This was a post-hoc subgroup analysis of multiple cohorts (Age, diabetes, hypertension, chronic kidney disease, and obesity) from the TICO (The ticagrelor monotherapy after 3 months in the patients treated with new generation sirolimus stent for acute coronary syndrome) study. The co-primary outcomes that were measured were major bleeding events and major adverse cardiac and cerebrovascular events. Results Compared to DAPT, ticagrelor monotherapy significantly decreases risk of major bleeding events in patients &gt;65 (HR 0.48; 95% CI 0.24–0.95), without diabetes (HR 0.48; 95% CI 0.25–0.94), without CKD (HR 0.48; 95% CI 0.25–0.95), and non-obese (HR 0.49; 95% CI 0.25–0.95). Ticagrelor monotherapy also decreases risk of major cardiac and cerebrovascular events in patients &gt;65 (HR 0.52; 95% CI 0.29–0.95) compared to DAPT. Conclusion This post-hoc subgroup analysis reveals that, in certain populations, ticagrelor monotherapy after a three month DAPT course significantly decreases risk of major bleeding events and major cardiac and cerebrovascular outcomes in patients with acute coronary syndrome. This is especially seen in the elderly population where risks of adverse events are higher. Nonetheless, larger studies need to be performed for further analysis. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals Intermediate vs Standard-dose Prophylactic Anticoagulation in Patients with COVID-19 Admitted to ICU: Ninety-day Results from the INSPIRATION Trial

2021 ◽  
Author(s):  
Behnood Bikdeli ◽  
Azita H Talasaz ◽  
Farid Rashidi ◽  
Hooman Bakhshandeh ◽  
Farnaz Rafiee ◽  
...  
Keyword(s):  
Hospital Discharge ◽  
Major Bleeding ◽  
Arterial Thrombosis ◽  
Dose Group ◽  
Standard Dose ◽  
Controlled Trial ◽  
Bleeding Events ◽  
Major Bleeding Events ◽  
Prophylactic Anticoagulation ◽  
Intermediate Dose

Background: Thrombotic complications are considered among the main extrapulmonary manifestations of COVID-19. The optimal type and duration of prophylactic antithrombotic therapy in these patients remain unknown. Methods: This manuscript reports the final (90-day) results of the Intermediate versus Standard-dose Prophylactic anticoagulation In cRitically-ill pATIents with COVID-19: An opeN label randomized controlled trial (INSPIRATION) study. Patients with COVID-19 admitted to intensive care were randomized to intermediate-dose versus standard-dose prophylactic anticoagulation for 30 days, irrespective of hospital discharge status. The primary efficacy outcome was a composite of adjudicated venous or arterial thrombosis, treatment with extracorporeal membrane oxygenation (ECMO), or all-cause death. The main safety outcome was major bleeding. Results: Of 600 randomized patients, 562 entered the modified intention-to-treat analysis (median age [Q1, Q3]; 62 (50, 71) years; 237 (42.2%) women), of whom 336 (59.8%) survived to hospital discharge. The primary outcome occurred in 132 (47.8%) of patients assigned to intermediate-dose and 130 (45.4%) patients assigned to standard-dose prophylactic anticoagulation (hazard ratio [HR]: 1.21, 95% confidence interval [CI]: 0.95-1.55, P=0.11). No significant differences were observed between the two groups for other efficacy outcomes, or in the landmark analysis from days 31-90. Overall, there were 7 (2.5%) major bleeding events in the intermediate-dose group (including 3 fatal events) and 4 (1.4%) major bleeding events in the standard-dose group (none fatal) (HR: 1.82, 95% CI: 0.53-6.24, P=0.33). Conclusion: Intermediate-dose compared with standard-dose prophylactic anticoagulation did not reduce a composite of death, treatment with ECMO, or venous or arterial thrombosis at 90-day follow-up.

scholarly journals Efficacy and Safety of Long‐Term Antithrombotic Strategies in Patients With Chronic Coronary Syndrome: A Network Meta‐analysis of Randomized Controlled Trials

2021 ◽  
Author(s):  
Houyong Zhu ◽  
Xiaoqun Xu ◽  
Xiaojiang Fang ◽  
Fei Ying ◽  
Liuguang Song ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Major Bleeding ◽  
Meta Analysis ◽  
Efficacy And Safety ◽  
Bleeding Events ◽  
Coronary Syndrome ◽  
High Risk Factors ◽  
Cerebrovascular Events

Background Long‐term antithrombotic strategies for patients with chronic coronary syndrome with high‐risk factors represent an important treatment dilemma in clinical practice. Our aim was to conduct a network meta‐analysis to evaluate the efficacy and safety of long‐term antithrombotic strategies in patients with chronic coronary syndrome. Methods and Results Four randomized studies were included (n=75167; THEMIS [Ticagrelor on Health Outcomes in Diabetes Mellitus Patients Intervention Study], COMPASS [Cardiovascular Outcomes for People Using Anticoagulation Strategies], PEGASUS‐TIMI 54 [Prevention of Cardiovascular Events in Patients With Prior Heart Attack Using Ticagrelor Compared to Placebo on a Background of Aspirin–Thrombolysis in Myocardial Infarction 54], and DAPT [Dual Anti‐platelet Therapy]). The odds ratios (ORs) and 95% CIs) were calculated as the measure of effect size. The results of the network meta‐analysis showed that, compared with aspirin monotherapy, the ORs for trial‐defined major adverse cardiovascular and cerebrovascular events were 0.86; (95% CI, 0.80–0.93) for ticagrelor plus aspirin, 0.89 (95% CI, 0.78–1.02) for rivaroxaban monotherapy, 0.74 (95% CI, 0.64–0.85) for rivaroxaban plus aspirin, and 0.72 (95% CI, 0.60,–0.86) for thienopyridine plus aspirin. Compared with aspirin monotherapy, the ORs for trial‐defined major bleeding were 2.15 (95% CI, 1.78–2.59]) for ticagrelor plus aspirin, 1.51 (95% CI, 1.23–1.85) for rivaroxaban monotherapy, and 1.68 (95% CI, 1.37–2.05) for rivaroxaban plus aspirin. For death from any cause, the improvement effect of rivaroxaban plus aspirin was detected versus aspirin monotherapy (OR, 0.76; 95% CI, 0.65–0.90), ticagrelor plus aspirin (OR, 0.79; 95% CI, 0.66–0.95), rivaroxaban monotherapy (OR, 0.82; 95% CI, 0.69–0.97), and thienopyridine plus aspirin (OR, 0.58; 95% CI, 0.41–0.82) regimens. Conclusions All antithrombotic strategies combined with aspirin significantly reduced the incidence of major adverse cardiovascular and cerebrovascular events and increased the risk of major bleeding compared with aspirin monotherapy. Considering the outcomes of all ischemic and bleeding events and all‐cause mortality, rivaroxaban plus aspirin appears to be the preferred long‐term antithrombotic regimen for patients with chronic coronary syndrome and high‐risk factors.

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