The FDA Approves Ticagrelor for Primary Prevention in High Risk Patients

The FDA has approved the indication of ticagrelor as primary prevention in high risk CAD patients with no history of MI or stroke. 

La FDA aprueba el ticagrelor en pacientes de alto riesgo como prevención primaria

The lab producing ticagrelor has informed the FDA has based this decision on the THEMIS study, which included nearly 20,000 patients with stable CAD and type 2 diabetes.

This decision has come as a surprise for many, given the delicate balance this study has shown in terms of risk/benefit ratio, let alone the cost of this drug. 

In the THEMIS, ticagrelor significantly reduced the combined end point of major cardiovascular events (cardiovascular death, MI or stroke) compared against placebo (both arms received aspirin). This difference was significant, but in absolute terms event reduction was lower than 1% (7.7% vs 8.5%; p=0.04).


Read also: ESC 2019 | THEMIS: Ticagrelor in Diabetics with Stable Coronary Artery Disease.


In addition, this event reduction happened at the cost of a two-fold increase in major bleeding (2.2% vs.1.0%; p<0.001) and also intracranial bleeding (0.7% vs. 0.5%; p=0.005).


Read also: ESC 2019 | THEMIS-PCI: Unlike in the Main Study, Here Ticagrelor Is Indeed Effective.


In fact, when the THEMIS was presented last year at the ESC by Deepak Bhatt (one of the authors) it was said that for stable CAD patients with diabetes and no history of MI or stroke, the risk of bleeding counterbalanced the benefit of ticagrelor. 


Read also: THEMIS: Ischemic and Hemorrhagic Events in Delicate Balance for Chronic Ticagrelor.


Original Title: Brilinta approved in the US to reduce the risk of a first heart attack or stroke in high-risk patients with coronary artery disease.

Reference: AstraZeneca. Publicado el 01/06/2020.


Subscribe to our weekly newsletter

Get the latest scientific articles on interventional cardiology

We are interested in your opinion. Please, leave your comments, thoughts, questions, etc., below. They will be most welcome.

More articles by this author

STEACS and the Use of Bivalirudin vs. Heparin: In Search of BRIGHT-4 Outcomes

Various studies and registries have previously shown the impact of post-percutaneous coronary intervention (PCI) complications on the survival of patients with ST-segment elevation acute...

TAVR and Atrial Fibrillation: What Anticoagulants Should We Use?

The prevalence of atrial fibrillation (AF) in TAVR patients ranges from 15 to 30%, depending on series. This arrhythmia has been associated to higher...

Ultrathin vs Thin-Strut Stents in PCI Patients at High Bleeding Risk

Several in vivo studies have shown that ultrathin stents present lower thrombogenic risk vs. thin-strut stents, which reflects in lower rates of target lesion...

Should We Withdraw Anticoagulation Before TAVR?

Approximately one-third of patients undergoing transcatheter aortic valve replacement (TAVR) have atrial fibrillation and are on oral anticoagulant (OAC) therapy. This creates a complex...

LEAVE A REPLY

Please enter your comment!
Please enter your name here

Related Articles

SOLACI Sessionsspot_img

Recent Articles

TCT 2024 | FAVOR III EUROPA

The study FAVOR III EUROPA, a randomized trial, included 2,000 patients with chronic coronary syndrome, or stabilized acute coronary syndrome, and intermediate lesions. 1,008...

TCT 2024 | TRISCEND II

This randomized study included 400 patients; 267 were treated with EVOQUE valve and 133 with optimal medical treatment (OMT). After one-year follow-up, there were no...

TCT 2024 – ACCESS-TAVI: Comparing Percutaneous Access Closure Strategies After TAVI

Vascular access complications following transcatheter aortic valve implantation (TAVI) remain common. However, few studies compare vascular access closure methods.  Based on the CHOICE-CLOSURE and MASH...