Long-term Tolerability of Ticagrelor for the Secondary Prevention of Major Adverse Cardiovascular Events
Why the study?
Does ticagrelor increase discontinuation of treatment compared to placebo in stable outpatients with prior myocardial infarction?
Population
21,162 stable outpatients with prior myocardial infarction
Comparison
Ticagrelor 90 mg twice daily or 60 mg twice… vs Placebo, with all patients receiving a low dose…
Design
RCT, randomly assigned
Follow-up
median of 33 months
Authors
Discussion
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Implication
Higher ticagrelor discontinuation from bleeding or dyspnea may limit adherence in stable post-MI patients; leaves open optimal long-term dosing and support strategies.
Key Points
- To investigate the reasons and timing of discontinuation of ticagrelor treatment among stable patients post-myocardial infarction.
- Randomized trial with 21,162 stable outpatients with prior myocardial infarction
- Participants received either 90 mg or 60 mg of ticagrelor twice daily or placebo along with aspirin
- Follow-up lasted a median of 33 months to evaluate treatment discontinuation.
- 32%, 29%, and 21% discontinuation rates for 90 mg, 60 mg ticagrelor, and placebo respectively (P < .001).
- 19%, 16%, and 9% of patients discontinued due to adverse events (P < .001).
- Bleeding and dyspnea were the most common adverse events leading to discontinuation, with rates of 7.8%, 6.2%, and 1.5% for bleeding (P < .001) and 6.5%, 4.6%, and 0.8% for dyspnea (P < .001).
Structured PICO
Does ticagrelor increase discontinuation of treatment compared to placebo in stable outpatients with prior myocardial infarction?
P
Population
21,162 stable outpatients with prior myocardial infarction
I
Intervention
Ticagrelor 90 mg twice daily or 60 mg twice daily, with all patients receiving a low dose of aspirin
C
Comparator
Placebo, with all patients receiving a low dose of aspirin
O
Outcome
Discontinuation of treatmentsafety
Discontinuation of ticagrelor in stable patients with prior MI is primarily driven by early, nonserious adverse events like bleeding and dyspnea, emphasizing the importance of patient counseling to maintain adherence.
Cite This Study
Bonaca et al. (2016) studied this question.