Courtesy of Dr. Agustín Vecchia. Nearly 10% of patients with acute coronary syndrome (ACS) require surgery. Managing periprocedural dual antiplatelet therapy (DAPT) in ACS patients is controversial and, to date, there are no randomized trials in this regard. Guidelines recommend ticagrelor discontinuation five days prior surgery and in the most emblematic work on this drug...
Diabetic patients are increased risk of thrombotic events, which is why an effective antiplatelet therapy is crucial for these patients. Both prasugrel and ticagrelor have shown to reduce thrombotic complications further than clopidogrel. Subgroup analyzes of the most important studies testing prasugrel and ticagrelor vs. clopidogrel have shown that diabetic patients receiving the new...
The choice of prasugrel or ticagrelor for patients with acute myocardial infarction undergoing primary angioplasty makes no difference, at least in the short term. This study was terminated prematurely and thus lost statistical power, which means that any interpretation of the lack of difference between the two antiplatelet drugs must take into account such...
Ticagrelor might be a more effective antiplatelet therapy than aspirin for the prevention of recurrent stroke and cardiovascular events in patients admitted for acute cerebral ischemia. This double-blind, controlled trial randomized 13,199 patients from 33 countries. Subjects presented a non-severe stroke or a high-risk transient ischemic attack (TIA) (not considered as cardioembolic) and had not received...
All studies on diabetics have shown these patients have higher risk rates of thrombotic events. This study sought to determine the optimal antiaggregation therapy with ticagrelor to prevent thrombotic events in diabetic patients with prior MI. The study analyzed diabetic patient and non-diabetic patient subgroups (n=6806 and n=14355, respectively) from the PEGASUS–TIMI 54...
Original Title: Ticagrelor for Prevention of Ischemic Events after Myocardial Infarction in Patients with Peripheral Artery Disease. Reference: Marc P. Bonaca et al. J Am Coll Cardiol. 2016 Jun 14;67(23):2719-28. Peripheral artery disease is associated with high rates of ischemic and bleeding events in patients with prior myocardial infarction. This study evaluates the safety...
Original Title: Pharmacodynamic Effects of Switching from Prasugrel to Ticagrelor Results of the Prospective, Randomized SWAP-3 Study Reference: J Am Coll Cardiol Intv. 2016;() Epub ahead of print. Courtesy of Dr. Agustín Vecchia. At present, the pharmacodynamic effects of switching from prasugrel to ticagrelor in patients under dual APT remain unknown. The present prospective, randomized,...
Original Title: Effects of Ticagrelor versus Clopidogrel in Troponin-Negative Patients With Low-Risk ACS Undergoing Ad Hoc PCI. Reference: Dominick J et al. J Am Coll Cardiol. 2016;67(6):603-613. Many patients admitted with low-risk acute coronary syndrome (ACS) are not pre-treated with a P2Y12 receptor inhibitors despite the invasive strategy in place, with angiography and PCI in the...
Original Title: Long-term tolerability of ticagrelor for secondary prevention: insights from PEGASUS-TIMI 54 trial. Presenter: Bonaca MP. The higher rate of premature discontinuation of ticagrelor vs placebo in the PEGASUS-TIMI 54 of stable outpatients with prior MI is attributed to more frequent dyspnea and bleeding, according to a new study. Among patients who tolerated therapy for...
This double-blind study included 21162 patients with a history of acute myocardial infarction randomized to ticagrelor 90 mg e/12 h, ticagrelor 60 mg e/12 h or placebo. All patients received aspirin and had additional risk factors such as age or diabetes. The history of infarction should be between one and three years before being included...