Original title: Stent thrombosis with ticagrelor versus clopidogrel in patients with acute coronary syndromes: An analysis from the prospective randomized PLATO trial. Reference: Steg PG et al. Circulation. 2013; Epub ahead of print
The PLATO study randomized 18624 patients with acute coronary syndrome to receive ticagrelor (180 mg loading dose followed by 90 mg twice daily ) or clopidogrel ( 300 or 600 mg loading dose followed by 75 mg per day ) . The results of this study published in NEJM showed a reduction in the composite of cardiac death , heart attack and stroke ( primary end point ) .
This paperwork reported the results of 61% of patients in the PLATO (n = 11289 ) who received angioplasty with stent either prior to study ( n = 1404 ) or during the same ( n = 9885 ) . At 12 months the definitive in-stent thrombosis was significantly lower with ticagrelor compared with clopidogrel ( 1.37 % versus 1.93 % , HR 0.67 , CI 0.5-0.9 , p = 0.0091 ) .The result was similar when considering all thrombosis together (definite, probable and possible) with 2.94 % for ticagrelor branch versus 3.77 % for the clopidogrel branch (HR 0.77, CI 0.62 to 0.95 , P = 0.013 ) .
The definitive thrombosis rate was consistently lower with ticagrelor beyond the type of acute coronary syndrome , diabetes , drug-eluting stent use , use of glycoprotein IIbIIIa , etc). Out of 147 cases with definite thrombosis furthermost were subacute (58.5 % ) , followed by late thrombosis (24.5 %) and acute ( 17 % ) .Ticagrelor decreased subacute thrombosis and late but not acute ( within 24 hours).Patients with stent thrombosis showed a higher risk of bleeding and death from all causes after the event than they had before.
Conclusion:
Ticagrelor compared with clopidogrel reduces the incidence of stent thrombosis in patients with acute coronary syndromes , with a benefit consisting of a wide range of patients , stents and treatment characteristics .
Editorial Comment:
Although the absolute difference in stent thrombosis is small, this complication is associated with a high mortality rate and myocardial infarction (confirmed in this study once more).
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