How is stent thrombosis prevented in acute coronary syndrome (ACS)?

Updated: Sep 30, 2020
  • Author: David L Coven, MD, PhD; Chief Editor: Eric H Yang, MD  more...
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Prevention of stent thrombosis

A subgroup analysis of the PLATO trial indicated that treatment with ticagrelor resulted in a lower risk of stent thrombosis than treatment with clopidogrel in patients with ACS. [80, 81] This benefit was independent of patient characteristics at baseline, including type of ACS and stent type.

Of the 18,624 ACS patients in the PLATO study, 11,289 (61%) had a previous stent implanted or received one during the trial. [81] Of these, 177 patients (1.6%) had a definite stent thrombosis (176 of them within 1 year), and 275 (2.5%) had definite or probable stent thrombosis.

Definite stent thrombosis occurred in 1.37% of patients treated with ticagrelor and 1.93% of those treated with clopidogrel—a 33% reduction in risk with ticagrelor. [81] Definite or probable stent thrombosis occurred in 2.21% of ticagrelor-treated patients and 2.87% of those who received clopidogrel—a 25% reduction in risk with ticagrelor. Overall, the risk of definite, probable, or possible stent thrombosis was reduced by 23% with ticagrelor.

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