- For patients with ST-elevation myocardial infarction (STEMI) treated with fibrinolytic therapy, ticagrelor (Brilinta, Amneal) showed similar safety and efficacy to clopidogrel (Plavix, Bristol-Myers Squibb) at 12 months.
- Result is exploratory.
- Editorial performed meta-analysis of TREAT and PLATO, linking ticagrelor to 13% relative risk reduction of cardiovascular death, myocardial infarction, or stroke in patients with STEMI.
Why this matters
- Dual antiplatelet therapy (DAPT) with aspirin and clopidogrel reduces major cardiovascular events in patients with STEMI.
- Ticagrelor acts faster and offers better P2Y12 inhibition vs clopidogrel.
- PLATO demonstrated lower rate of cardiovascular events with ticagrelor after primary percutaneous coronary intervention (PCI) in a STEMI population not treated with fibrinolytics.
- TREAT has already reported acceptable 30-day safety results.
- Ticagrelor vs clopidogrel:
- Primary outcome: 6.7% (129/1913) vs 7.3% (137/1886); HR, 0.93 (95% CI, 0.73-1.18; P=.53).
- Dyspnea: 23.9% vs 13.7%.
- Similar between-group rate of major, fatal, and intracranial bleeding.
- Minor bleeding more frequent with ticagrelor.
- International, multicenter, randomized, open-label TREAT (n=3799).
- Participants aged
- They were randomly assigned to daily ticagrelor vs clopidogrel.
- Outcome: 12-month composite of cardiovascular mortality, myocardial infarction, or stroke.
- Funding: AstraZeneca.
- Underpowered to assess 12-month efficacy.
- Older patients excluded.