scholarly journals Age‐Dependent Effect of Ticagrelor Monotherapy Versus Ticagrelor With Aspirin on Major Bleeding and Cardiovascular Events: A Post Hoc Analysis of the TICO Randomized Trial

2021 ◽  
Author(s):  
Byung Gyu Kim ◽  
Sung‐Jin Hong ◽  
Byeong‐Keuk Kim ◽  
Seung‐Jun Lee ◽  
Chul‐Min Ahn ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Major Bleeding ◽  
Cardiovascular Events ◽  
Treatment Strategies ◽  
Dependent Effect ◽  
Post Hoc Analysis ◽  
Coronary Syndrome ◽  
End Point ◽  
Age Dependent ◽  
Post Hoc

Background We aimed to evaluate the age‐dependent effect of ticagrelor monotherapy after 3‐month dual‐antiplatelet therapy (DAPT) versus ticagrelor‐based 12‐month DAPT on major bleeding and cardiovascular events in patients with acute coronary syndrome. Methods and Results From the TICO trial (Ticagrelor Monotherapy After 3 Months in the Patients Treated With New Generation Sirolimus‐eluting Stent for Acute Coronary Syndrome), which randomized 3056 patients (median age, 61 years) to the ticagrelor monotherapy after 3‐month DAPT group or ticagrelor‐based 12‐month DAPT group, this post hoc analysis evaluated the age‐dependent effect of the treatment strategies on the primary end point (a composite of major bleeding, death, myocardial infarction, stent thrombosis, stroke, or target‐vessel revascularization) using the subpopulation treatment effect pattern plot. The cutoff age for distinguishing patients with greater benefit from this strategy was also determined. The risk reduction effect of ticagrelor monotherapy after 3‐month DAPT versus ticagrelor‐based 12‐month DAPT on the primary end point gradually increased with age and was more marked from the subpopulation of age 64 years with the change point. With this cutoff value of 64 years, the occurrence of the primary end point was significantly lower in the ticagrelor monotherapy after 3‐month DAPT group than in the ticagrelor‐based 12‐month DAPT group (4.4% versus 9.0%; P =0.002) in patients aged ≥64 years (n=1278), but it was not different in those aged <64 years (n=1778) with a significant interaction ( P ‐interaction=0.036). Conclusions The age‐dependent increase in the benefit of ticagrelor monotherapy after 3‐month DAPT versus ticagrelor‐based 12‐month DAPT was observed in the patients with acute coronary syndrome. In elderly patients with acute coronary syndrome, ticagrelor monotherapy after short‐term DAPT might be more optimal than ticagrelor‐based 12‐month DAPT.

scholarly journals Effect of Ticagrelor Monotherapy vs Ticagrelor With Aspirin on Major Bleeding and Cardiovascular Events in Patients With Acute Coronary Syndrome

JAMA ◽  
2020 ◽  
Vol 323 (23) ◽  
pp. 2407 ◽  
Author(s):  
Byeong-Keuk Kim ◽  
Sung-Jin Hong ◽  
Yun-Hyeong Cho ◽  
Kyeong Ho Yun ◽  
Yong Hoon Kim ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Major Bleeding ◽  
Cardiovascular Events ◽  
Coronary Syndrome

scholarly journals Combined glycoprotein IIb/IIIa inhibitor therapy with ticagrelor for patients with acute coronary syndrome

PLoS ONE ◽  
2021 ◽  
Vol 16 (2) ◽  
pp. e0246166
Author(s):  
Zhi-Jiang Xie ◽  
Shuan-Li Xin ◽  
Chao Chang ◽  
Hai-Jing Zhou ◽  
Xiu-Feng Zhao ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Ischemic Stroke ◽  
Combination Therapy ◽  
Cardiogenic Shock ◽  
Stent Thrombosis ◽  
Major Bleeding ◽  
Cardiovascular Events ◽  
Coronary Syndrome ◽  
Major Cardiovascular Events ◽  
All Cause Mortality

This study was to compare the efficacy and safety of combined glycoprotein IIb/IIIa inhibitor (GPI) and ticagrelor versus ticagrelor in patients with acute coronary syndrome (ACS). An observational study was conducted using the Improving Care for Cardiovascular Disease in China-ACS project. Totally, 13,264 patients with ACS and received combination therapy or ticagrelor therapy were analyzed. The primary outcome was the composite of major cardiovascular events (MACE: all-cause mortality, myocardial infarction [MI], stent thrombosis, cardiogenic shock, and ischemic stroke), and secondary outcomes included all-cause mortality, MI, stent thrombosis, cardiogenic shock, and ischemic stroke. The multivariable adjusted analysis indicated that combination therapy was associated with an increased risk of major cardiovascular events (MACE) (P = 0.001), any bleeding (P<0.001), and major bleeding (P = 0.005). Moreover, the multivariable adjusted for propensity score-matched (PSM) analysis suggested that combination therapy produced additional risk of MACE (P = 0.014), any bleeding (P<0.001), and major bleeding (P = 0.005). Moreover, PSM analysis suggested that combination therapy was associated with greater risk of stent thrombosis (P = 0.012) and intracranial bleeding (P = 0.020). Combined GPI and ticagrelor therapies did not have any beneficial effects on MACE, stent thrombosis, intracranial bleeding, any bleeding, or major bleeding.

Combination of fondaparinux with radial access is associated with low rates of in-hospital MACE and major bleeding events in patients with acute coronary syndrome

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J.V Santos Pereira Ramos ◽  
L Fonteles Ritt ◽  
E Sahade Darze ◽  
M.A Viana ◽  
M.C Oliveira ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Primary Endpoint ◽  
Major Bleeding ◽  
Cardiovascular Events ◽  
Multivariable Analysis ◽  
Hospital Length Of Stay ◽  
Femoral Access ◽  
Coronary Syndrome ◽  
Radial Access ◽  
Hospitalization Period

Abstract Background Fondaparinux and radial access use were associated with lower rates of cardiovascular events in patients with acute coronary syndrome (ACS). The benefits of combining these two treatment strategies are not well described. Methods In 1167 consecutive patients admitted for ACS who underwent an invasive treatment strategy, data on the primary combined endpoint – major bleeding (OASIS-5 criteria) and major adverse cardiovascular events (MACE) – were prospectively collected for the hospitalization period and compared according to anticoagulation regimen (Fondaparinux or Enoxaparin) and arterial access site (femoral vs radial). Results Overall, mean age was 65±12 years, 57% were male, 32% had diabetes and 17% presented with ST segment elevation myocardial infarction (STEMI). Fondaparinux and radial access were used in 756 (65%) and 554 (48%) patients, respectively. An endpoint occurred in 112 patients (9.6%) – MACE in 79 (6.8%) and major bleeding in 42 (3.6%). Endpoint was 3.4% in Fondaparinux plus radial access, 9.9% for Fondaparinux plus femoral access, 8% Enoxaparin plus radial access and 19.9% in enoxaparin plus femoral access (p&lt;0.001). Fondaparinux use was associated with a significant reduction in the rate of the primary endpoint in both radial (RR 0.42 CI 95% 0.19–0.90; p&lt;0.05) and femoral (RR 0.5 CI 95% 0.33–0.79; p&lt;0.001) access patients. The primary endpoint was also reduced in the radial access patients regardless if Fondaparinux (RR 0.33 CI 95% 0.18–0.62; p&lt;0.001) or Enoxaparin (RR 0.40 CI 95% 0.21–0.74; p&lt;0.01) was used. In multivariable analysis (adjusted for age, sex, diabetes, heart failure, previous CABG, creatinine, ejection fraction, haemoglobin, STEMI, and hospital length of stay) Fondaparinux (OR 0.50 CI 95% 0.31–0.79; p&lt;0.01) and radial access (OR 0.39 CI 95% 0.23–0.66; p&lt;0.001) where both independently associated with lower rates of primary endpoint. There was no interaction between both variables (p=0.83). Conclusion The use of fondaparinux plus radial access was associated with the lowest rates of MACE and major bleeding when compared with either strategy alone and therefore, is a very attractive approach to be used routinely in patients with ACS. Funding Acknowledgement Type of funding source: None

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 Risk factors for major adverse cardiovascular events after the first acute coronary syndrome

2021 ◽  
Vol 53 (1) ◽  
pp. 817-823
Author(s):  
Marjo Okkonen ◽  
Aki S. Havulinna ◽  
Olavi Ukkola ◽  
Heikki Huikuri ◽  
Arto Pietilä ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Coronary Syndrome ◽  
Cardiovascular Events ◽  
Major Adverse Cardiovascular Events ◽  
Coronary Syndrome
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