What question did this study set out to answer?

September 25, 2019Circulation

Clinically Significant Bleeding With Ticagrelor Versus Clopidogrel in Korean Patients With Acute Coronary Syndromes Intended for Invasive Management

View Full Paper

Ask AI

Bookmark

Why the study?

Owing to differential propensity for bleeding and ischemic events with antiplatelet therapy, the safety and effectiveness of ticagrelor in East Asian populations remained uncertain.

Does ticagrelor increase clinically significant bleeding compared to clopidogrel in Korean patients with acute coronary syndromes intended for invasive management?

Key Points

To compare the safety and efficacy of standard-dose ticagrelor versus clopidogrel in Korean patients with acute coronary syndromes undergoing invasive management.
Conducted a multicenter randomized trial (NCT02094963) enrolling 800 Korean patients with acute coronary syndromes intended for invasive management.
Randomly assigned participants in a 1:1 ratio to receive ticagrelor (180 mg loading, 90 mg twice daily) or clopidogrel (600 mg loading, 75 mg daily) for 12 months.
Evaluated the primary safety outcome of clinically significant bleeding (composite of PLATO major or minor bleeding) at 12 months.
Clinically significant bleeding occurred in 11.7% (45/400) of patients in the ticagrelor group versus 5.3% (21/400) in the clopidogrel group (HR, 2.26; 95% CI, 1.34 to 3.79; P =0.002).
Major bleeding (7.5% [29/400] vs 4.1% [16/400]; P =0.04) and fatal bleeding (1.0% [4/400] vs 0% [0/400]; P =0.04) were significantly more frequent with ticagrelor.
The composite ischemic outcome of cardiovascular death, myocardial infarction, or stroke occurred in 9.2% (36/400) with ticagrelor versus 5.8% (23/400) with clopidogrel (HR, 1.62; 95% CI, 0.96 to 2.74; P =0.07).

Structured PICO

Does ticagrelor increase clinically significant bleeding compared to clopidogrel in Korean patients with acute coronary syndromes intended for invasive management?

Population

800 Korean patients hospitalized for acute coronary syndromes with or without ST elevation and intended for invasive management

Intervention

Ticagrelor (180 mg loading dose, 90 mg twice daily thereafter)

Comparator

Clopidogrel (600 mg loading dose, 75 mg daily thereafter)

Outcome

Clinically significant bleeding (a composite of major bleeding or minor bleeding according to PLATO criteria) at 12 monthssafety

In Korean patients with acute coronary syndromes intended for invasive management, standard-dose ticagrelor was associated with a significantly higher risk of clinically significant bleeding compared to clopidogrel.

Limitations

Underpowered to draw any conclusion regarding efficacy

Discussion

No takes yet. Share an insight, caveat, or question.

Implication

Supports preferring clopidogrel to minimize bleeding in Korean ACS patients; confirms ticagrelor’s excess risk in East Asians.

Cite This Study

Park et al. (2019) studied this question.

synapsesocial.com/papers/6a7d4d3c7786afdcaca00eb9 https://doi.org/10.1161/circulationaha.119.041766

Topics

Dual antiplatelet therapy Percutaneous coronary intervention

View Full Paper

Ask AI

Bookmark

Clinically Significant Bleeding With Ticagrelor Versus Clopidogrel in Korean Patients With Acute Coronary Syndromes Intended for Invasive Management

Key Points

Structured PICO

Limitations

Discussion

Implication

Cite This Study

Topics

Clinically Significant Bleeding With Ticagrelor Versus Clopidogrel in Korean Patients With Acute Coronary Syndromes Intended for Invasive Management

Key Points

Structured PICO

Limitations

Discussion

Implication

Cite This Study

Also Consider

Topics

Also Consider