Ticagrelor Bests Clopidogrel for Reducing Stent-Thrombosis Risk: PLATO

August 02, 2013

PARIS, FRANCE — Treatment with ticagrelor (Brilinta, AstraZeneca) results in a lower risk of stent thrombosis when compared withclopidogrel in the setting of acute coronary syndromes (ACS), an analysis of the Platelet Inhibition and Patient Outcomes (PLATO) trial shows [1].

"The benefit of ticagrelor in reducing definite stent thrombosis appeared independent of baseline variables, such as type of ACS, diabetes, geographic region of enrollment, clopidogrel CYP2C19 genotype, prerandomization dose of aspirin and clopidogrel, and stent type (bare metal or drug eluting)," write Dr Gabriel Steg (Centre Hospitalier Bichaut-Claude Bernard, Paris, France) and colleagues in their report, published online July 30, 2013 in Circulation.

As reported by heartwire , the PLATO study showed that treatment of ACS patients with the oral antiplatelet agent ticagrelor significantly reduced the rate of MI/stroke/cardiovascular death compared with clopidogrel. The drug was approved by the US Food and Drug Administration in 2011.

Of the 18 624 patients hospitalized with ACS in PLATO, 11 289 (61%) had a previous stent implanted or received one during the trial. Just over half of patients treated underwent genetic testing to determine CYP2C19 genetic status. In total, 177 patients (1.6%) had a definite stent thrombosis, and all but one had the event within one year (the other patient had a stent thrombosis on day 378); while 275 patients (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 difference that translated into a 33% lower risk with ticagrelor. 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 favoring ticagrelor. In addition, the risk of definite, probable, or possible stent thrombosis was reduced 23% with ticagrelor.

"In the present subgroup analysis of the PLATO trial in patients with coronary stents, ticagrelor compared with clopidogrel reduced the incidence of stent thrombosis, regardless of the definition used," report the researchers. "While there was no statistical difference in acute stent thrombosis (but with a small total number of events, 25), both subacute and late stent thromboses were markedly reduced."

Steg has received research grants from NYU School of Medicine, Sanofi, Servier; consultancy fees/honoraria from Amarin, Astellas, AstraZeneca, Bayer, Boehringer-Ingelheim, Bristol-Myers Squibb, Daiichi/sankyo, GlaxoSmithKline, Lilly, Medtronic, MerckSharpeDohme, Novartis, Otsuka, Pfizer, Roche, Sanofi, Servier, the Medicines Company, and Vivus. Disclosures for the coauthors are listed in the paper.

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