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09/11/2009 - News

Ticagrelor May Be Better Option in Acute Coronary Syndrome

By: June Chen, MD


Acute coronary syndrome is the general term for any group of clinical symptoms compatible with an acute insufficiency of blood supply to the heart muscle due to coronary artery disease. Thus, acute coronary syndrome spans the spectrum from angina to heart attack. Platelet inhibitors such as clopidogrel, or Plavix, have been shown to improve outcomes in patients with acute coronary syndrome.

Now, as published online August 30, 2009 in the New England Journal of Medicine, scientists report that ticagrelor, or Brilinta, significantly reduces the rate of death from vascular causes, heart attack, or stroke compared with clopidogrel.

Investigators from the Study of Platelet Inhibition and Patients Outcomes (PLATO) performed a multicenter, double-blind, randomized trial comparing ticagrelor and clopidogrel for the prevention of cardiovascular events in 18,624 patients admitted to the hospital with an acute coronary syndrome. At 12 months, the investigators found the death from vascular causes, heart attack, or stroke had occurred in 9.8% of acute coronary syndrome patients receiving ticagrelor as compared with 11.7% of those receiving clopidogrel. This reduction was statistically significant. There was also a significant reduction in the rate of death from any cause among those acute coronary syndrome patients receiving ticagrelor.
A potentially fatal side effect of platelet inhibition is major bleeding. The PLATO investigators found no significant difference in the rates of major bleeding between the ticagrelor and clopidogrel groups, although ticagrelor was associated more instances of fatal bleeding within the brain. Based on these findings, the investigators conclude that, in patients who have an acute coronary syndrome, treatment with ticagrelor significantly reduced the rate of death from vascular causes, myocardial infarction, or stroke without an increase in the rate of overall major bleeding.


NEJM. Published at August 30, 2009.

Created on: 09/11/2009
Reviewed on: 09/11/2009

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