Comparison of Clinical Effectiveness of Ticagrelor and Clopidogrel in Post Percutaneous Transluminal Coronary Angioplasty (PTCA) Patients Approaching A Tertiary Care Hospital in South India

Abstract

Introduction: Dual antiplatelet therapy is recommended for prevention of secondary cardiovascular events in acute coronary syndrome patients who undergo percutaneous transluminal coronary angioplasty (PTCA). This therapy includes aspirin with either of a P 2 Y 12 platelet receptor inhibitor like clopidogrel or ticagrelor. Methodology: A retrospective cohort study with 1 year follow up which compared clopidogrel and ticagrelor for determining clinical effectiveness in post PTCA patients through the incidence of primary and secondary end points. Primary end points included cardiovascular death, Myocardial Infarction (MI), unstable angina, secondary revascularization and Congestive Heart Failure (CHF). Secondary end points were bleeding and dyspnea. Results: Age, gender, cardiovascular risk factors, concomitant medications administered and angioplasty specifications like the number of stents, type of stents and approach route were in comparable between clopidogrel and ticagrelor groups. The primary end points, a composite of cardiovascular death, unstable angina and secondary revascularization occurred more in the clopidogrel group (9%) than in ticagrelor group (5%) in 12 months follow up period. The secondary end points, a composite of bleeding and dyspnea were observed more in the ticagrelor group (11%) compared to clopidogrel group (5%). Conclusion: The use of ticagrelor prevents the incidence of secondary cardiovascular events in post PTCA patients to a greater degree than clopidogrel in comparable risk groups. Our observation revealed that ticagrelor was found to be better drug than clopidogrel as a prophylactic antiplatelet drug though there was increased incidence of dyspnea and bleeding in ticagrelor group. Key words: Antiplatelets, Ticagrelor, Clopidogrel.