期刊
CIRCULATION
卷 122, 期 21, 页码 2131-2141出版社
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1161/CIRCULATIONAHA.109.927582
关键词
acute coronary syndrome; hemorrhage; myocardial infarction; platelets; thrombosis
资金
- AstraZeneca
- sanofi-aventis
- Servier
- Astellas
- Bayer
- Boehringer-Ingelheim,
- Bristol-Myers Squibb
- Daiichi-Sankyo
- Endotis
- Glaxo Smith Kline
- Menarini
- Medtronic
- Merck-Sharpe-Dohme
- Nycomed
- Otsuka
- Pierre Fabre
- Schering Plough
- Eli-Lilly
- Portola Pharmaceuticals
- Novartis
- Merck
- Millenium Pharmaceuticals
- Medicines Co
- Pfizer
- Boston Scientific
- Regado Biosciences
- Daichii Sankyo
- Accumetrics
- Intekrin Therapeutics
- Merck/Schering Plough Partnership
- Takeda
- Eli Lilly/Daiichi Sankyo Alliance
- Dynabyte
- Teva
- Regado
- Athera
Background-Aspirin and clopidogrel are recommended for patients with acute coronary syndromes (ACS) or undergoing coronary stenting. Ticagrelor, a reversible oral P2Y12-receptor antagonist, provides faster, greater, and more consistent platelet inhibition than clopidogrel and may be useful for patients with acute ST-segment elevation (STE) ACS and planned primary percutaneous coronary intervention. Methods and Result-Platelet Inhibition and Patient Outcomes (PLATO), a randomized, double-blind trial, compared ticagrelor with clopidogrel for the prevention of vascular events in 18 624 ACS patients. This report concerns the 7544 ACS patients with STE or left bundle-branch block allocated to either ticagrelor 180-mg loading dose followed by 90 mg twice daily or clopidogrel 300-mg loading dose (with provision for 300 mg clopidogrel at percutaneous coronary intervention) followed by 75 mg daily for 6 to 12 months. The reduction of the primary end point (myocardial infarction, stroke, or cardiovascular death) with ticagrelor versus clopidogrel (10.8% versus 9.4%; hazard ratio [HR], 0.87; 95% confidence interval, 0.75 to 1.01; P=0.07) was consistent with the overall PLATO results. There was no interaction between presentation with STE/left bundle-branch block and randomized treatment (interaction P=0.29). Ticagrelor reduced several secondary end points, including myocardial infarction alone (HR, 0.80; P=0.03), total mortality (HR, 0.82; P=0.05), and definite stent thrombosis (HR, 0.66; P=0.03). The risk of stroke, low in both groups, was higher with ticagrelor (1.7% versus 1.0%; HR, 1.63; 95% confidence interval, 1.07 to 2.48; P=0.02). Ticagrelor did not affect major bleeding (HR, 0.98; P=0.76). Conclusion-In patients with STE-ACS and planned primary percutaneous coronary intervention, the effects of ticagrelor were consistent with those observed in the overall PLATO trial.
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