Ticagrelor compared against clopidogrel produces more bleeding and also more deaths in patients over 80 recently undergoing acute myocardial infarction. Contrary to what has been observed in the general population, these data from the SWEDEHEART registry of post MI patients over 80, show higher bleeding and mortality rates with ticagrelor compared against clopidogrel. These findings...
The FDA has approved the indication of ticagrelor as primary prevention in high risk CAD patients with no history of MI or stroke. 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...
Switching to ticagrelor monotherapy after 3 months of dual antiplatelet therapy reduces major bleeding without paying a price in terms of ischemic events, compared with dual antiplatelet therapy for a year, in patients who had acute coronary syndrome and underwent angioplasty with a second-generation drug-eluting stent. Interrupting aspirin at 3 months and switching it for ticagrelor reduces...
The original TWILIGHT findings in more than 9000 patients who underwent angioplasty were presented last year at TCT and showed a 3.1% absolute risk reduction in BARC 2, 3, or 5 bleeding with no increase in death, infarction, or stroke in patients who received ticagrelor and placebo compared with patients who received ticagrelor and aspirin. All patients...
In parallel to the TWILIGHT in patients with complex PCI, Dr. Angiolillo virtually presented the sub-study in diabetic patients, and it was published simultaneously in J Am Coll Cardiol. This study focuses on the clinical complexity of patients, rather than the technical complexity of the procedure itself. The TWILIGHT-DM analyzed 2620 diabetic patients from the...
The GLOBAL LEADERS study includes a pre-specified sub-study, GLASSY, that showed that ticagrelor monotherapy after one month of dual antiplatelet therapy is non-inferior (but not superior) to conventional treatment in terms of ischemic events. As regards safety, ticagrelor monotherapy did not decrease major bleeding compared with conventional therapy. The GLOBAL LEADERS randomized 15,991 patients who required...
The THEMIS study published this week in NEJM, tested chronic ticagrelor + aspirin in diabetic patients with stable coronary artery disease (CAD), but with no prior history of Myocardial infarction (MI) or stroke. The tempting hypothesis behind this study is that reducing ischemic events might increase bleeding events, and this calls for careful cost/benefit assessment. ...
Courtesy of Dr. Carlos Fava. The benefit of dual antiplatelet therapy in acute coronary syndromes (ACS) has been proven long ago, and both prasugrel and ticagrelor have offered best results than clopidogrel. However, nowadays, it is unclear which of them is superior in the long term, taking into account the fact that one starts to...
This is a sub-study of the THEMIS presented during the ESC 2019 scientific sessions in Paris, and simultaneously published in Lancet. They were all diabetics with stable coronary artery disease, but in this sub-study patients also had prior PCI. It included over 11000 patients with prior PCI for whom the combination of ticagrelor and aspirin...
The use of ticagrelor in patients with stable coronary artery disease significantly reduces the rate of major cardiovascular events when compared against aspirin, according to this study presented on Sunday at ESC 2019 simultaneously published in NEJM, though the cost in terms of major bleeding seems unacceptable. Primary end point rate (composite of cardiovascular death,...