Abstract | AIMS: METHODS AND RESULTS: For the current analysis the primary endpoint was 1-year mortality and the secondary safety endpoint was moderate or severe bleedings until hospital discharge with respect to three different ADP-receptor antagonists. 856 patients were eligible for analysis. Of these, 507 patients (59.2%) received clopidogrel, 178 patients (20.8%) prasugrel and 171 patients (20.0%) ticagrelor as acute antiplatelet therapy. The adjusted rate of mortality after 1-year did not differ significantly between prasugrel and clopidogrel (hazard ratio [HR]: 0.81, 95% confidence interval [CI] 0.60-1.09, padj = 0.17) or between ticagrelor and clopidogrel treated patients (HR: 0.86, 95% CI 0.65-1.15, padj = 0.31). In-hospital bleeding events were significantly less frequent in patients treated with ticagrelor vs. clopidogrel (HR: 0.37, 95% CI 0.20 -0.69, padj = 0.002) and not significantly different in patients treated with prasugrel vs. clopidogrel (HR: 0.73, 95% CI 0.43 -1.24, padj = 0.24). CONCLUSION: This pooled sub-analysis is the largest analysis on safety and efficacy of three oral ADP-receptor antagonists and shows that acute therapy with either clopidogrel, prasugrel or ticagrelor is no independent predictor of 1-year mortality. Treatment with ticagrelor seems independently associated with less in-hospital moderate and severe bleeding events compared to clopidogrel. This finding might be due to selection bias and should be interpreted with caution.
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Authors | Martin Orban, Jan Kleeberger, Taoufik Ouarrak, Anne Freund, Hans-Josef Feistritzer, Georg Fuernau, Tobias Geisler, Kurt Huber, Dariusz Dudek, Marko Noc, Gilles Montalescot, Alexander Neumer, Paul Haller, Peter Clemmensen, Uwe Zeymer, Steffen Desch, Steffen Massberg, Steffen Schneider, Holger Thiele, Jörg Hausleiter |
Journal | Clinical research in cardiology : official journal of the German Cardiac Society
(Clin Res Cardiol)
Vol. 110
Issue 9
Pg. 1493-1503
(Sep 2021)
ISSN: 1861-0692 [Electronic] Germany |
PMID | 33999281
(Publication Type: Comparative Study, Journal Article, Multicenter Study, Randomized Controlled Trial)
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Copyright | © 2021. The Author(s). |
Chemical References |
- Platelet Aggregation Inhibitors
- Clopidogrel
- Prasugrel Hydrochloride
- Ticagrelor
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Topics |
- Aged
- Aged, 80 and over
- Clopidogrel
(administration & dosage, adverse effects)
- Female
- Follow-Up Studies
- Hemorrhage
(chemically induced)
- Humans
- Intra-Aortic Balloon Pumping
(methods)
- Male
- Middle Aged
- Myocardial Infarction
(complications, mortality, therapy)
- Percutaneous Coronary Intervention
- Platelet Aggregation Inhibitors
(administration & dosage, adverse effects)
- Prasugrel Hydrochloride
(administration & dosage, adverse effects)
- Prospective Studies
- Shock, Cardiogenic
(mortality, therapy)
- Ticagrelor
(administration & dosage, adverse effects)
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