Key result
Triple antithrombotic therapy with ticagrelor or prasugrel resulted in a 40% rate of net adverse clinical events compared to 27% with clopidogrel (P=0.35) in patients with STEMI after PCI.
Why the study?
Most literature on triple antithrombotic therapy after PCI fails to adequately represent patients with STEMI and those prescribed potent P2Y12 inhibitors like ticagrelor or prasugrel.
Does triple antithrombotic therapy with ticagrelor or prasugrel compared to clopidogrel reduce net adverse clinical events in patients with ST-elevation myocardial infarction undergoing percutaneous coronary intervention?
Cohort (n=46)
No
Does triple antithrombotic therapy with ticagrelor or prasugrel compared to clopidogrel reduce net adverse clinical events in patients with ST-elevation myocardial infarction undergoing percutaneous coronary intervention?
In a small retrospective cohort of STEMI patients on triple antithrombotic therapy, the use of ticagrelor or prasugrel compared to clopidogrel showed no significant difference in net adverse clinical events, though the study was underpowered.
Nonsignificant increase in events with potent P2Y12 inhibitors in triple therapy; leaves open optimal regimen selection in STEMI post-PCI.
Background: Patients on dual antiplatelet therapy following percutaneous coronary intervention often have indications for concomitant oral anticoagulation, known as triple antithrombotic therapy. Majority of literature evaluating triple antithrombotic therapy fails to adequately represent patients with ST-elevation myocardial infarction and those prescribed potent P2Y12 inhibitors, ticagrelor or prasugrel. The purpose of this study was to evaluate the safety and efficacy of triple antithrombotic regimens containing ticagrelor or prasugrel versus clopidogrel after percutaneous coronary intervention in the setting of ST-elevation myocardial infarction. Methods: This was a single-center, retrospective cohort trial. The primary endpoint was net adverse clinical event, defined as the primary efficacy endpoint of death, myocardial infarction, or cerebrovascular accident and the primary safety endpoint of any bleeding event. Results: Between October 2017 and October 2019, a total of 65 patients with ST-elevation myocardial infarction were initiated on triple therapy. Forty-six patients were included in the primary analysis, of which 26 were discharged on triple antithrombotic therapy with clopidogrel and 20 discharged on potent P2Y12 inhibitors (ticagrelor or prasugrel). The primary endpoint occurred in 27% of the clopidogrel group and 40% of the potent P2Y12 inhibitor group ( P = 0.35). Bleeding occurred in 23% of the clopidogrel group and 35% of the potent P2Y12 inhibitor group ( P = 0.37). Conclusions: This small cohort study suggests, in patients with ST-elevation myocardial infarction undergoing percutaneous coronary intervention, the net adverse clinical event rate does not differ between clopidogrel and potent P2Y12 inhibitors in the setting of triple antithrombotic therapy. The results of this exploratory analysis warrant confirmation in a larger, randomized study.
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Gill et al. (2021) conducted a cohort in ST-elevation myocardial infarction (n=46). Triple antithrombotic therapy with ticagrelor or prasugrel vs. Triple antithrombotic therapy with clopidogrel was evaluated on Net adverse clinical event (death, myocardial infarction, cerebrovascular accident, or any bleeding event) (p=0.35). Triple antithrombotic therapy with ticagrelor or prasugrel resulted in a 40% rate of net adverse clinical events compared to 27% with clopidogrel (P=0.35) in patients with STEMI after PCI.
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