Key result
Ticagrelor is linked to ~53% more bleeding than clopidogrel in DOAC-treated ACS patients without reducing MACE.
Why the study?
Does ticagrelor reduce major adverse cardiovascular events compared to clopidogrel in orally anticoagulated patients with acute coronary syndrome undergoing percutaneous coronary intervention?
Cohort (n=3,708)
Yes
Does ticagrelor reduce major adverse cardiovascular events compared to clopidogrel in orally anticoagulated patients with acute coronary syndrome undergoing percutaneous coronary intervention?
In ACS patients on oral anticoagulation undergoing PCI, ticagrelor as part of dual antithrombotic therapy increases bleeding risk without improving ischemic outcomes compared to clopidogrel.
May favor clopidogrel to limit bleeding without MACE gain; leaves open need for RCTs in anticoagulated ACS-PCI patients.
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Emilsson et al. (2026) conducted a cohort in Acute coronary syndrome in orally anticoagulated patients undergoing percutaneous coronary intervention (n=3,708). Ticagrelor vs. Clopidogrel was evaluated on Major adverse cardiovascular events (MACE; including mortality, myocardial infarction, and stroke) (aHR 1.02, 95% CI 0.84-1.23). In ACS patients on DOACs undergoing PCI, ticagrelor was associated with an increased risk of bleeding compared with clopidogrel (aHR 1.53; 95% CI 1.06-2.22), with no difference in MACE.
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