Efficacy Of Ticagrelor Research Articles

Evaluating the Safety and Efficacy of Ticagrelor vs. Clopidogrel Following Percutaneous Coronary Intervention in Chronic Coronary Disease

Evaluating the Safety and Efficacy of Ticagrelor vs. Clopidogrel Following Percutaneous Coronary Intervention in Chronic Coronary Disease

Platelet-derived circFAM13B associated with anti-platelet responsiveness of ticagrelor in patients with acute coronary syndrome

BackgroundPlatelet is enriched with Circular RNAs (circRNAs), with circFAM13B rank among the 10 most abundant circRNAs in platelets. The aim of the present study was to evaluate the predictive value of platelet-derived circFAM13B for the antiplatelet responsiveness and efficacy of ticagrelor in patients with acute coronary syndrome (ACS).MethodsConsecutive ACS patients treated with ticagrelor were enrolled, and the antiplatelet responsiveness of 3 days of ticagrelor maintenance treatment was assessed by measuring the adenosine diphosphate (ADP)-induced platelet inhibition rate (ADP%) using thromboelastography. The expression of circFAM13B in the patients’ platelets was analyzed by quantitative real-time polymerase chain reaction. The correlation between circFAM13B expression and ticagrelor antiplatelet responsiveness, as well as the independent contribution of circFAM13B to the composite of adverse ischemic events during a follow-up period of at least 12 months was evaluated.ResultsA total of 129 eligible ACS patients treated with ticagrelor were enrolled in the study. A negative correlation was found between the expression of circFAM13B and the ADP% value (r = -0.41, P < 0.001). Patients with ADP% ≥ 76% had a significantly lower level of circFAM13B compared to those with ADP% < 76% (adjusted P = 0.009). Receiver operating characteristic curve analysis demonstrated that combining circFAM13B expression > 1.05 with clinical risk factors could effectively predict the risk of adverse ischemic events (AUC = 0.81, 95% CI: 0.69 to 0.92, P < 0.001). Kaplan-Meier survival analysis showed that patients with circFAM13B > 1.05 had a significantly higher risk of adverse ischemic events compared to those with circFAM13B ≤ 1.05 (P = 0.003). Multivariate logistic hazard analysis identified circFAM13B > 1.05 as an independent risk factor for adverse ischemic events in in ticagrelor-treated ACS patients (adjusted OR: 5.60, 95% CI: 1.69–18.50; P = 0.005).ConclusionsPlatelet-derived circFAM13B could be utilized for predicting the antiplatelet responsiveness and efficacy of ticagrelor in patients with ACS.

Ticagrelor vs Clopidogrel for Complex Percutaneous Coronary Intervention in Chronic Coronary Syndrome

BackgroundWhether ticagrelor in chronic coronary syndrome patients undergoing complex percutaneous coronary intervention (PCI) can prevent cardiovascular events is unknown. ObjectivesThe authors sought to evaluate outcomes of complex PCI and the efficacy of ticagrelor vs clopidogrel in stable patients randomized in the ALPHEUS (Assessment of Loading with the P2Y12 inhibitor ticagrelor or clopidogrel to Halt ischemic Events in patients Undergoing elective coronary Stenting) trial. MethodsAll PCI procedures were blindly reviewed and classified as complex if they had at least 1 of the following criteria: stent length >60 mm, 2-stent bifurcation, left main, bypass graft, chronic total occlusion, use of atherectomy or guiding catheter extensions, multiwire technique, multiple stents. The primary endpoint was a composite of type 4a or b myocardial infarction (MI) and major myocardial injury during the 48 hours after PCI. We compared the event rates according to the presence or not of complex PCI criteria and evaluated the interaction with ticagrelor or clopidogrel. ResultsAmong the 1,866 patients randomized, 910 PCI (48.3%) were classified as complex PCI. The primary endpoint was more frequent in complex PCI (45.6% vs 26.6%; P < 0.001) driven by higher rates of type 4 MI and angiographic complications (12.2% vs 4.8 %; P < 0.001 and 19.3% vs 8.6%; P < 0.05, respectively). The composite of death, MI, and stroke at 48 hours (12.7% vs 5.1 %; P < 0.05) and at 30 days (13.4% vs 5.3%; P < 0.05) was more frequent in complex PCI. No interaction was found between PCI complexity and the randomized treatment for the primary endpoint (Pinteraction = 0.47) nor the secondary endpoints. ConclusionsIn chronic coronary syndrome, patients undergoing a complex PCI have higher rates of periprocedural and cardiovascular events that are not reduced by ticagrelor as compared with clopidogrel.

Comparison of In-Hospital Major Adverse Cardiovascular Events in Patients with Acute Myocardial Infarction Treated with Ticagrelor or Clopidogrel in the Emergency Department: A Propensity Score Matched Retrospective Cohort Study.

Dual antiplatelet therapy (DAPT) is a standard treatment option for acute myocardial infarction (AMI). The difference between the efficacy of ticagrelor and clopidogrel in the emergency department (ED) before percutaneous coronary intervention (PCI) remains unknown. The present study compared the in-hospital major adverse cardiovascular event (MACE) rates between patients with AMI treated with clopidogrel and those treated with ticagrelor in the ED before PCI. We retrospectively collected the data of patients diagnosed as having AMI in the ED. Patients were only included if they had successfully received complete DAPT with aspirin and ticagrelor/clopidogrel in the ED and had undergone PCI. The patients were divided into two groups according to their DAPT regimen. The primary outcome was the rate of in-hospital MACEs. The secondary outcomes included an unexpected return to the ED within 72 h, readmission within 14 d, and revascularization. A total of 1836 patients were enrolled. Patients in the ticagrelor group had a lower in-hospital MACE rate (3.01% versus 7.51%, p < 0.001) and in-hospital mortality rate (2.15% versus 5.70%, p < 0.001) than those in the clopidogrel group. Multivariate logistic regression analysis revealed ticagrelor was independently associated with a lower risk of in-hospital MACEs (odds ratio [OR]: 0.53, 95% CI: 0.32-0.88, p = 0.013). After propensity score matching, the risk of in-hospital MACEs remained significantly lower in the ticagrelor group (OR 0.42, 95% CI: 0.21-0.85, p = 0.016). DAPT with ticagrelor and aspirin in the ED before PCI is associated with a lower in-hospital MACE rate among patients with AMI.

TCTAP A-021 Safety and Efficacy of Ticagrelor or Clopidogrel in East Asian Patients With Acute Coronary Syndrome and Diabetes Mellitus

TCTAP A-021 Safety and Efficacy of Ticagrelor or Clopidogrel in East Asian Patients With Acute Coronary Syndrome and Diabetes Mellitus

Ticagrelor Versus Clopidogrel in East Asian Patients With Acute Coronary Syndrome and Diabetes Mellitus.

It is still unknown whether diabetes mellitus (DM) affects the relative safety and efficacy of ticagrelor vs clopidogrel in East Asian patients with acute coronary syndrome (ACS). The authors sought to assess the safety and efficacy of ticagrelor vs clopidogrel according to the diabetic status of East Asian patients with ACS undergoing invasive management. This prespecified analysis of the TICA KOREA (Clinically Significant Bleeding With Ticagrelor Versus Clopidogrel in Korean Patients With Acute Coronary Syndromes Intended for Invasive Management) trial included 800 Korean patients. The primary safety endpoint was clinically significant bleeding (PLATO [Platelet Inhibition and Clinical Outcomes] major or minor bleeding) at 12months; the efficacy endpoint was major adverse cardiovascular events (cardiovascular death, myocardial infarction, and stroke). Of 800 patients, 216 (27.0%) had DM. The incidence of clinically significant bleeding within 12months was significantly higher with ticagrelor than clopidogrel in the nondiabetic group (10.2% vs 4.3%; HR: 2.45; 95%CI: 1.27-4.70; P=0.007) and tended to be higher in the diabetic group (13.8% vs 8.0%; HR: 1.87; 95%CI: 0.54-4.36; P=0.15); there was no significant interaction between treatment-arm and DM (P for interaction=0.64). The incidences of major adverse cardiovascular events were not significantly different after ticagrelor or clopidogrel both in the diabetic group (10.8% vs 6.0%; HR: 1.90; 95%CI: 0.71-5.07; P=0.20) and in the nondiabetic group (8.5% vs 5.7%; HR: 1.51; 95%CI: 0.81-2.81; P=0.19) without significant interaction (P-for-interaction=0.71). In Korean ACS patients undergoing early invasive management, diabetes status did not affect therelative safety and efficacy of ticagrelor and clopidogrel. (Safety and Efficacy of Ticagrelor Versus Clopidogrel in Asian/Korean Patients With Acute Coronary Syndromes Intended for Invasive Management [TICA KOREA]; NCT02094963).

Clinical outcomes with the use of ticagrelor or clopidogrel after fibrinolytic therapy in patients with ST-elevation myocardial infarction – A prospective observational study

Background: Thrombolytic therapy in the appropriate window period remains the most commonly used therapy in ST-elevation myocardial infarction patients, despite the advantage of primary percutaneous coronary intervention (PCI) over it. Use of newer more potent antiplatelets agents early after thrombolysis carries the chance of increasing bleeding complications, thus we planned to have a study to assess the safety and efficacy of ticagrelor as compared to clopidogrel in thrombolysed patients. Materials and Methods: This was a prospective observational study in Indian patients. A total of 142 patients were enrolled in the study with 76 in the ticagrelor group and 66 in the clopidogrel group. All patients received thrombolysis as the primary reperfusion strategy. Patients receiving either clopidogrel or ticagrelor after thrombolysis irrespective of the subsequent PCI status were followed up for any bleeding events (primary endpoints) as per thrombolysis in myocardial infarction (TIMI) definition and Bleeding Academic Research Consortium (BARC) definition. Major adverse cardiac events (MACE) including death from cardiovascular causes, myocardial infarction (MI), and stroke were also assessed as markers of efficacy and secondary endpoints. Results: Mean time from thrombolysis to study drug use was 18.9 ± 2.1 h in the ticagrelor group as compared to 14.8 ± 3.3 h in the clopidogrel group (P &gt; 0.05). For major bleeding events (TIMI major), no statistically significant difference was observed between groups (2.6% in ticagrelor vs. 1.5% in clopidogrel) (P = 0.6). BARC 3–5 bleeding at 1-month follow-up was significantly higher in the ticagrelor group compared to the clopidogrel group (P = 0.04). At 1-month follow-up, BARC 1–2 or 3–5 bleeding events in the subjects who underwent PCI were higher in the ticagrelor group than the clopidogrel group (P = 0.03). Patients in the clopidogrel group have more major adverse cardiac events than the ticagrelor group especially driven by more fatal and nonfatal MI in the clopidogrel group (P = 0.04). Conclusions: Ticagrelor can be safely administered in postthrombolytic patients similar to clopidogrel albeit at the cost of slightly increased minor bleeding events in short-term follow-up.

Comparison of Clinical Outcomes Between Ticagrelor and Clopidogrel in Elderly Patients Undergoing Percutaneous Coronary Intervention: A Cohort Study.

BackgroundAge is a strong predictor of adverse outcomes due both to a higher risk of bleeding and ischemia. The purpose of this study was to evaluate the safety and efficacy of ticagrelor in elderly patients.MethodsPatients ≥75 years of age admitted to our center from January, 2015 to December, 2019 who had undergone percutaneous coronary intervention (PCI) and received dual antiplatelet therapy (DAPT) were included in our study. Eligible patients were divided into clopidogrel and ticagrelor groups according to the P2Y12 receptor inhibitor and were followed up for 1 year. The primary safety endpoint was types 2, 3, and 5 bleeding, as defined by Bleeding Academic Research Consortium (BARC), and the primary efficacy endpoint was combined major adverse cardiovascular and cerebrovascular events (MACCEs). A Cox proportional hazard model and propensity score matching were used to correct confounding factors.ResultsOf 1505 patients enrolled in this study, 442 were assigned to ticagrelor group and 1063 were assigned to clopidogrel group. The incidence of BARC 2, 3, and 5 bleeding (HR, 2.304; 95% CI, 1.540–3.447), and any bleeding (HR, 2.476; 95% CI, 1.802–3.403) in ticagrelor group was significantly higher than clopidogrel group. There were no significant difference between the two groups with respect to BARC 3 and 5 bleeding (HR, 1.566; 95% CI, 0.767–3.198) and MACCEs (HR, 0.957; 95% CI, 0.702–1.305).ConclusionCompared with clopidogrel, DAPT with ticagrelor significantly increased the risk of BARC 2, 3, and 5 bleeding without reducing MACCEs in elderly patients who underwent PCI.Trial RegistrationThe study was retrospectively registered in clinicaltrials.gov (NCT 04999293).

Net clinical benefit of different strategies of dual antiplatelet therapy in elderly patients: Data from the praise registry

BackgroundThe safety and efficacy of potent P2Y12 inhibitors (Ticagrelor and Prasugrel) in dual antiplatelet therapy (DAPT) with aspirin in elderly acute coronary syndrome (ACS) patients remains unclear. MethodsAll ACS patients aged 75 years and older treated with Percutaneous Coronary Intervention (PCI) from PRAISE dataset were included. The safety and efficacy of Ticagrelor vs Clopidogrel was evaluated with inverse probability of treatment weighting (IPTW). Sensitivity analysis was performed for patients older or equal than 85 years old. All-cause mortality was the primary endpoint, while myocardial infarction (MI), Bleeding Academic Research Consortium (BARC) 3–5 bleedings and Major and Net Adverse Clinical and Cardiac Events (MACE and NACE) were the secondary ones. Results4287 patients were included, 3197 treated with Clopidogrel and 1090 with Ticagrelor. After 16 ± 3 months, Ticagrelor showed neutral effect on NACE and mortality (HR 0.98; 0.63–1.52, p = 0.94 and HR 0.38; 0.14–1.04, p = 0,06), reduced risk of MACE and MI (HR 0.82; 0.23–0.91, p = 0.03 and HR 0.43; 0.14–0.89, p = 0.04) and increased risk of BARC 3–5 bleeding (HR 2.14; 1.19–3.85, p = 0.001). In very elderly patients (≥85 years) Ticagrelor decreased risk of MI and increased risk of bleeding (HR 0.69; 0.22–0.95, p = 0.04 and HR 2.36; 1.02–5.52, p = 0.04, all 95%CI) with neutral effect on NACE and MACE. ConclusionsIn elderly ACS patients treated with PCI, Ticagrelor was associated with neutral effect on all-cause mortality, lower risk MACE and MI compared with Clopidogrel. Such benefit was counterbalanced by increased risk of major bleedings. These results were consistent among patients aged 85 years and older.

817 Potent P2Y12 inhibitors in elderly population, insigth from praise registry

Abstract Background The safety and efficacy of potent P2Y12 inhibitors (Ticagrelor and Prasugrel) in dual antiplatelet therapy (DAPT) with aspirin in elderly patients with acute coronary syndrome (ACS) remains unclear. Methods All ACS patients aged 75 years and older treated with Percutaneous Coronary Intervention (PCI) from PRAISE dataset were included. The safety and efficacy of Ticagrelor vs Clopidogrel was evaluated with inverse probability of treatment weighting (IPTW). Sensitivity analysis was performed for patients older or equal than 85 years old. All-cause mortality was the primary endpoint, while myocardial infarction (MI), Bleeding Academic Research Consortium (BARC) 3-5 bleedings and Major and Net Adverse Clinical and Cardiac Events (MACE and NACE) were the secondary ones. Results 4287 patients were included, 3197 treated with Clopidogrel and 1090 with Ticagrelor. After 16±3 months, Ticagrelor showed neutral effect on NACE and mortality (HR 0.98; 0.63-1.52, p=0.94 and HR 0.38; 0.14-1.04, p=0,06), reduced risk of MACE and MI (HR 0.82; 0.23-0.91, p=0.03 and HR 0.43; 0.14-0.89, p=0.04) and increased risk of BARC 3-5 bleeding (HR 2.14; 1.19-3.85, p=0.001). In very elderly patients (≥85 years) Ticagrelor decreased risk of MI and increased risk of bleeding (HR 0.69; 0.22-0.95, p=0.04 and HR 2.36; 1.02-5.52, p=0.04, all 95%CI) with neutral effect on NACE and MACE. Conclusions In elderly ACS patients treated with PCI, Ticagrelor was associated with neutral effect on all-cause mortality, lower risk MACE and MI compared with Clopidogrel. Such benefit was counterbalanced by increased risk of major bleedings. These results were consistent among patients aged 85 years and older. 817 Figure 1

Ticagrelor versus clopidogrel in stent-assisted coil embolization of unruptured intracranial aneurysms.

Dual antiplatelet therapy is widely used for stent-assisted coil embolization (SACE) for unruptured intracranial aneurysms (UIAs) to prevent thromboembolic events (TEs). Compared to clopidogrel associated with aspirin, knowledge of the safety and efficacy of ticagrelor is lacking in large studies to date. A retrospective cohort study was conducted from January 2016 to December 2018 with at least one year of follow-up in a single institution and systemic review. Altogether, 153 patients with UIA receiving SACE were separated into two groups: 113 patients receiving clopidogrel plus aspirin and 40 patients receiving ticagrelor plus aspirin. Acute in-stent thrombotic events were noted in two patients in the clopidogrel group (1.77%) and none in the ticagrelor group (0%). Additionally, one patient (0.88%) in the clopidogrel group had an early ischemic stroke (<3 months). Delayed ischemic stroke was noted in 6 patients (5.31%) in the clopidogrel group and 3 patients (7.50%) in the ticagrelor group. There were no major hemorrhagic events in either group. The two groups showed no significant differences with regard to ischemic stroke or hemorrhagic stroke. Compared to the clopidogrel based regimen, ticagrelor can also reduce TEs without increasing bleeding tendency for SACE of UIAs. Ticagrelor combined with low-dose aspirin is a safe and effective alternative option for SACE.

Ticagrelor or clopidogrel after acute coronary syndrome in the elderly: a propensity score matching analysis from 16 653 patients included in two large multinational registries

Abstract Background Higher risk of bleeding with ticagrelor over clopidogrel in elderly patients with acute coronary syndrome (ACS) has been suggested. Purpose We assessed the incidence of major bleeding (MB), reinfarction (REAMI), and all-cause death in elderly patients to evaluate the safety and efficacy of ticagrelor versus clopidogrel in a population at high risk of bleeding and ischemia treated with percutaneous coronary intervention (PCI). Methods RENAMI and BleeMACS, real-world registries of patients with ACS who underwent PCI and received dual antiplatelet therapy, were merged. The pooled cohort was divided into two groups, clopidogrel versus ticagrelor and propensity score matching (PSM) analysis performed. Statistical analysis considered two age groups (&amp;lt;75 versus ≥75 years). Endpoints were BARC 3–5 MB, REAMI and all-cause death at 1 year. Independent risk factors of MB were identified. Results The study included 16,653 patients (13,153 &amp;lt;75 and 3,500 ≥75 years). Ticagrelor was underused in elderly patients (16.3% versus 20.8%, P&amp;lt;0.001). Using PSM, two treatment groups of 1,566 patients were included in the final analysis. Ticagrelor appeared to prevent REAMI (hazard ratio [HR], 0.31; 95% confidence interval [CI], 0.2–0.6; P&amp;lt;0.001) and all-cause death (HR, 0.60; 95% CI, 0.4–0.9; P=0.026) irrespective of age. In patients ≥75 years, ticagrelor increased the incidence of MB compared with clopidogrel (HR, 1.49; 95% CI, 0.70–3.0; P=0.257) without statistical significance; ticagrelor was found to significantly reduce all-cause death (HR, 0.32; 95% CI, 0.1–0.8; P=0.012) and REAMI (HR, 0.25; 95% CI, 0.1–1.1, P=0.072) without statistical significance. Multiple Cox regression revealed that age (HR, 1.03; 95% CI, 1.02–1.05; P&amp;lt;0.001) was an independent risk factor for bleeding, whereas hemoglobin level was inversely proportional to bleeding (HR, 0.80; 95% CI, 0.72–0.88; P&amp;lt;0.001). Conclusions Ticagrelor did not significantly increase MB compared with clopidogrel in elderly patients hospitalized for ACS and treated with PCI, significantly improving 1-year survival. Further studies on elderly patients are required. Funding Acknowledgement Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Astra Zeneca

Efficacy and safety of ticagrelor versus clopidogrel in patients with non-ST-elevation myocardial infarction in Taiwan

The clinical efficacy of ticagrelor versus clopidogrel has not been replicated in East Asian populations. The pronounced bleeding risk with ticagrelor was of concern given the increased bleeding tendency in Asian populations. This study evaluated efficacy and safety of ticagrelor versus clopidogrel in patients with non-ST-elevation myocardial infarction (NSTEMI) in the entire Taiwan. We used the Taiwan National Health Insurance Research Database to identify 6203 patients aged ≥ 20 years with NSTEMI hospitalization and prescription of dual antiplatelets at discharge between January 2014 and December 2014. Cohorts of ticagrelor and clopidogrel were matched 1:1 based on propensity score matching to balance baseline covariates. The primary composite efficacy endpoints included death from any cause, non-fatal myocardial infarction, and non-fatal stroke. The secondary efficacy endpoints were the individual components. The primary safety endpoint was major bleeding requiring hospitalization. The incidence of primary efficacy endpoint was 20.3% in the ticagrelor users and 20.7% in the clopidogrel users (adjusted HR 0.94; 95% CI 0.73–1.22), with the median (interquartile range, IQR) follow-up period of 5.2 (2.3–8.5) months. The incidence of primary safety endpoint was 2.3% in the ticagrelor users and 3.2% in the clopidogrel users (adjusted HR 0.67; 95% CI 0.33–1.35). Regarding the secondary efficacy endpoint, patients treated with ticagrelor had significantly lower incidence of stroke (adjusted HR 0.44; 95% CI 0.21–0.94; p = 0.033). In this nationwide Taiwanese cohort of NSTEMI, treatment with ticagrelor after discharge, as compared to clopidogrel, had similar rates of ischemic composite events and major bleeding. Nevertheless, the median follow-up time was only 5.2 months, and the reduced stroke events with ticagrelor compared to clopidogrel needs further verification.

Ticagrelor or Prasugrel for Patients With Acute Coronary Syndrome Treated With Percutaneous Coronary Intervention

It is unclear whether ticagrelor or prasugrel hydrochloride is superior for patients with acute coronary syndrome (ACS) treated with percutaneous coronary intervention (PCI). To assess the safety and efficacy of ticagrelor vs prasugrel for patients with ACS treated with PCI. A prespecified analysis was performed of a postrandomization subgroup of 3377 patients who presented with ACS and were treated with PCI in the investigator-initiated, multicenter, phase 4, open-label Intracoronary Stenting and Antithrombotic Regimen: Rapid Early Action for Coronary Treatment 5 randomized clinical trial, conducted from September 1, 2013, to February 28, 2018. Statistical analysis was performed from September 1, 2020, to January 30, 2021. Analysis was performed according to the intention-to-treat principle. Patients were randomly assigned to a ticagrelor-based or prasugrel-based strategy. This analysis focuses on the subgroup of patients who underwent PCI that was formed after randomization. The primary end point was a composite consisting of all-cause death, myocardial infarction, or stroke at 12 months. The safety end point was Bleeding Academic Research Consortium (BARC) type 3 to 5 bleeding. The ticagrelor group comprised 1676 patients (1323 men [78.9%]; mean [SD] age, 64.4 [12.0] years), and the prasugrel group comprised 1701 patients (1341 men [78.8%]; mean [SD] age, 64.7 [12.0] years). The primary end point occurred for 162 patients (9.8%) in the ticagrelor group and 120 patients (7.1%) in the prasugrel group (hazard ratio [HR], 1.41; 95% CI, 1.11-1.78; P = .005). Myocardial infarction occurred in 88 patients (5.3%) in the ticagrelor group compared with 55 patients (3.8%) in the prasugrel group (HR, 1.67; 95% CI, 1.19-2.34; P = .003). The safety end point, BARC type 3 to 5 bleeding, occurred in 84 of 1672 patients (5.3%) in the ticagrelor group and 78 of 1680 patients (4.9%) in the prasugrel group (HR; 1.10; 95% CI, 0.81-1.50; P = .54). Among patients presenting with ACS who were treated with PCI, the incidence of the primary composite end point occurred less frequently for patients who received prasugrel compared with those who received ticagrelor. The incidence of bleeding events was comparable between the 2 groups. These results suggest that, for patients presenting with ACS who undergo PCI, a prasugrel-based strategy is superior to a ticagrelor-based strategy. However, because these observations are based on a postrandomization subgroup, these findings should be regarded as hypothesis generating and dedicated randomized clinical trials may be warranted to confirm these findings. ClinicalTrials.gov Identifier: NCT01944800.

Efficacy of ticagrelor in the treatment of stable coronary heart disease: A protocol of systematic review.

Background:This study will assess the efficacy and safety of ticagrelor in the treatment of patients with stable coronary heart disease (SCHD).Methods:We will search the following databases for relevant potential studies in Cochrane Library, MEDLINE, EMBASE, Web of Science, Google Scholar, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure. We will search all literature sources from inception to the present without limitations of language and publication status. We will only consider randomized controlled trials on exploring the efficacy and safety of ticagrelor for the treatment of SCHD. Investigators will separately examine studies, collect data and appraise study quality. Data synthesis and analysis will be performed using RevMan 5.3 software.Results:This study will summarize high quality synthesis of present evidence of ticagrelor for the treatment of SCHD.Conclusion:The findings of this study will provide evidence to appraise whether ticagrelor is effective for the treatment of patients with SCHD.OSF registration number:osf.io/fq69u.

Safety and efficacy of ticagrelor as single antiplatelet therapy in prevention of thromboembolic complications associated with the Pipeline Embolization Device (PED): multicenter experience

BackgroundFlow diversion (FD) is a common treatment modality for complex intracranial aneurysms. A major concern regarding the use of FD is thromboembolic events (TEE). There is debate surrounding the optimal...

Assessment of efficacy of ticagrelor versus clopidogrel in the treatment of myocardial infarction by 2D echocardiography

Myocardial infarction (MI) is the irreversible death of heart muscle due to prolonged lack of supply of oxygen resulting in decreased coronary blood flow and if untreated may lead to myocardial damage. Myocardial infarction may be due to several causes viz., coronary occlusion, ventricular hypertrophy, coronary artery emboli or coronary trauma. Drugs used for the treatment of MI includes vasodilators to dilate the arteries and veins, antiarrythmics, thrombolytics to dissolve clots, anti-thrombolytics to prevent thrombus formation, anti-platelet drugs, analgesics to reduce pain, cardiac depressants to control heart rate and contractions. Present study was undertaken to evaluate the efficacy of Ticagrelor v/s Clopidogrel the antiplatelet drugs indicated in patients to reduce the risk of myocardial infarction. Both the drugs act by preventing the formation of platelet clots and helps in the smooth flow of blood. Assessment of results was carried out by 2d Echo test to evaluate the efficacy of the treatment. Treatment with ticagrelor showed improved efficacy and safety by improving the ejection fraction, reducing the rate of stroke, reducing vascular abnormalities, showing no bleeding problems. No death is observed due to vascular problems in both the treatment. Ticagrelor revealed considerable recovery rate compared to clopidogrel. Study reports revealed that ticagrelorisefficient thanclopidogrel in the treatment of MI and is a better choice over clopidogrel to treat MI.

An evaluation of ticagrelor for the treatment of sickle cell anemia

ABSTRACT Introduction Ticagrelor is an antiplatelet agent approved for the treatment of patients with an acute coronary syndrome or a history of myocardial infarction. Considering the evidence demonstrating that ticagrelor-mediated inhibition of platelet activation and aggregation have beneficial effects in the treatment of thrombotic conditions, clinical studies have been conducted to evaluate the use of this drug for the treatment of sickle cell disease (SCD), demonstrating satisfactory tolerability and safety. Areas covered Clinical investigation has characterized the pharmacokinetic and pharmacodynamical profile, as well as the efficacy and safety of ticagrelor to prevent painful vaso-occlusive crisis (painful episodes and acute chest syndrome) in SCD patients. Expert opinion While phase 1 and 2 clinical trials demonstrated satisfactory tolerability and safety, the conclusion of phase 3 clinical trials is crucial to prove the efficacy of ticagrelor as a therapeutic option for the treatment of SCD. Thus, it is expected that ticagrelor, especially in combination with other drugs, will improve the clinical profile and quality of life of patients with SCD.

Real-world safety and efficacy of ticagrelor in patients with ST segment elevation myocardial infarction at Assiut University Heart Hospital

Objectives: The new generation antiplatelets are generally recommended by the current US and European guidelines. This article aimed to address the efficacy and safety of using ticagrelor in patients with ST-elevated acute coronary syndromes.Methods: This was a prospective observational study on 120 patients admitted to the Cardiology Care Unit of Assiut University Hospital with ST-segment elevation acute coronary syndrome, who were admitted for urgent revascularization and received aspirin and the P2Y12 antagonist ticagrelor. The patients were followed for three months between May 2018 and September 2019. The primary efficacy end point was the incidence of major adverse cardiovascular events (MACE).Results: At three months, the primary efficacy endpoint, a composite of cardiovascular death, myocardial infarction, or stroke - occurred in 11/120 (9.2%) patients. The primary safety endpoint, the incidence of major bleeding, was observed in two patients (1.7%) with no fatal bleedings. Minor and minimal bleeding occurred in 2.5% and 20.8% of patients, respectively. Other efficacy endpoints were myocardial infarction 4.2% and stent thrombosis (1.7%). Severe dyspnea found in 5.0% of patients and led to 1.7% ticagrelor discontinuation. Multivariate regression analysis revealed no association between bleeding and patients’ age, sex nor IV administration of glycoprotein IIb/IIIa inhibitor. Conclusion: The MACE with ticagrelor was higher than previously reported in most studies. Dyspnea rate was higher and more pronounced than bleeding rate. The majority of bleeding cases were minimal with no fatal major bleeding and no bleeding led to comorbidity.

Outcomes and strategy of tailored antiplatelet therapy with ticagrelor in patients undergoing transcarotid artery revascularization

ObjectiveAntiplatelet drug resistance is associated with periprocedural ischemic complications in patients undergoing intravascular stent implantation. Nonresponders are subject to increased risk of stent thrombosis and in-stent stenosis, and high on-treatment platelet reactivity (HTPR) is present in up to 44% of patients taking clopidogrel, a widely used component of dual antiplatelet therapy (DAPT). Evidence points to ticagrelor as a viable alternative to overcome HTPR on clopidogrel. Studies have shown fewer thromboembolic events with ticagrelor therapy; however, results on bleeding risk are mixed, and its safety and efficacy in hybrid operative techniques have yet to be established. Transcarotid artery revascularization (TCAR) is a hybrid procedure to treat severe carotid stenosis. The objective of this study was to establish the safety and efficacy of ticagrelor as part of DAPT in patients undergoing TCAR and to develop a protocol to ensure adequate antithrombotic protection throughout the operative course. MethodsData were collected retrospectively for patients undergoing TCAR on DAPT of aspirin and ticagrelor for symptomatic (≥50%) or asymptomatic (≥80%) carotid stenosis. Preoperative platelet reactivity was determined using Thromboelastography with Platelet Mapping (Haemonetics Corporation, Braintree, Mass), with adequate platelet reactivity defined as maximal amplitude produced by adenosine diphosphate <50 mm. The primary safety end point was 30-day major bleeding event rate. Primary efficacy end points were 30-day incidence of ipsilateral cerebrovascular ischemic event (stroke or transient ischemic attack), myocardial infarction, and death. Secondary end points were postoperative length of hospital stay, procedure time, and clamp/flow reversal time. ResultsSixty-seven TCAR procedures with patients receiving periprocedural DAPT of ticagrelor and aspirin were performed during the study period. Patients had an average age of 79 years, and 28 (42%) were symptomatic. The mean procedure time was 45.8 ± 9.2 minutes, with a mean clamp/flow reversal time of 4.8 ± 1.5 minutes, and mean postoperative length of hospital stay of 3.1 ± 2.2 days for inpatients and 1.3 ± 0.8 days for outpatients. Technical success was achieved in all cases, with no 30-day major bleeding events and no occurrence of ipsilateral cerebrovascular ischemic event, myocardial infarction, or death. ConclusionsInitial experience with ticagrelor as part of DAPT in patients undergoing TCAR demonstrated its safety and efficacy in both symptomatic and asymptomatic disease. No bleeding events or thromboembolic complications occurred. Furthermore, a protocol to administer ticagrelor to assay for HTPR on ticagrelor and consequent medication and patient management is proposed. Ticagrelor may represent a safe and effective alternative to overcome clopidogrel nonresponsiveness in DAPT regimens for TCAR.