Abstract | BACKGROUND: METHODS: In this multicenter, double-blind, randomized trial, we compared ticagrelor (180-mg loading dose, 90 mg twice daily thereafter) and clopidogrel (300-to-600-mg loading dose, 75 mg daily thereafter) for the prevention of cardiovascular events in 18,624 patients admitted to the hospital with an acute coronary syndrome, with or without ST-segment elevation. RESULTS: At 12 months, the primary end point--a composite of death from vascular causes, myocardial infarction, or stroke--had occurred in 9.8% of patients receiving ticagrelor as compared with 11.7% of those receiving clopidogrel (hazard ratio, 0.84; 95% confidence interval [CI], 0.77 to 0.92; P<0.001). Predefined hierarchical testing of secondary end points showed significant differences in the rates of other composite end points, as well as myocardial infarction alone (5.8% in the ticagrelor group vs. 6.9% in the clopidogrel group, P=0.005) and death from vascular causes (4.0% vs. 5.1%, P=0.001) but not stroke alone (1.5% vs. 1.3%, P=0.22). The rate of death from any cause was also reduced with ticagrelor (4.5%, vs. 5.9% with clopidogrel; P<0.001). No significant difference in the rates of major bleeding was found between the ticagrelor and clopidogrel groups (11.6% and 11.2%, respectively; P=0.43), but ticagrelor was associated with a higher rate of major bleeding not related to coronary-artery bypass grafting (4.5% vs. 3.8%, P=0.03), including more instances of fatal intracranial bleeding and fewer of fatal bleeding of other types. CONCLUSIONS:
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Authors | Lars Wallentin, Richard C Becker, Andrzej Budaj, Christopher P Cannon, Håkan Emanuelsson, Claes Held, Jay Horrow, Steen Husted, Stefan James, Hugo Katus, Kenneth W Mahaffey, Benjamin M Scirica, Allan Skene, Philippe Gabriel Steg, Robert F Storey, Robert A Harrington, PLATO Investigators, Anneli Freij, Mona Thorsén |
Journal | The New England journal of medicine
(N Engl J Med)
Vol. 361
Issue 11
Pg. 1045-57
(Sep 10 2009)
ISSN: 1533-4406 [Electronic] United States |
PMID | 19717846
(Publication Type: Comparative Study, Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
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Copyright | 2009 Massachusetts Medical Society |
Chemical References |
- Platelet Aggregation Inhibitors
- Purinergic P2 Receptor Antagonists
- Clopidogrel
- Ticagrelor
- Adenosine
- Ticlopidine
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Topics |
- Acute Coronary Syndrome
(drug therapy, mortality)
- Adenosine
(adverse effects, analogs & derivatives, therapeutic use)
- Aged
- Clopidogrel
- Double-Blind Method
- Dyspnea
(chemically induced)
- Electrocardiography
- Female
- Hemorrhage
(chemically induced)
- Humans
- Kaplan-Meier Estimate
- Male
- Myocardial Infarction
(mortality)
- Platelet Aggregation Inhibitors
(adverse effects, therapeutic use)
- Purinergic P2 Receptor Antagonists
- Stroke
(mortality)
- Ticagrelor
- Ticlopidine
(adverse effects, analogs & derivatives, therapeutic use)
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