• NEWS . 14 Sep 2020
  • Ticagrelor showed benefits in post-MI stroke prevention among East Asian patients: A nationwide cohort study

  • Ticagrelor improves clinical outcomes in patients with acute myocardial infarction (AMI). A study was conducted to compare the efficacy and safety of ticagrelor versus clopidogrel in East Asian patients with AMI.

    The study population comprised patients with AMI prescribed with dual antiplatelet therapy between July 2013 and December 2015, identified from the National Health Insurance Research Database of Taiwan. Using propensity score weighting, ticagrelor was compared with clopidogrel for the primary efficacy endpoint (a composite of all-cause death, MI and stroke) and bleeding.

    A total of 32,442 patients with AMI (ticagrelor, 10,057; clopidogrel, 22,385) were eligible for analysis. After propensity score weighting, ticagrelor was comparable to clopidogrel in the incidence rate of the primary efficacy endpoint (23.6 vs 22.76 per 100 patient-years; hazard ratio [HR], 0.97, 95% confidence interval [CI], 0.8–1.06; p=0.513). Ticagrelor was associated with a lower risk of stroke (1.78 vs 2.66 per 100 patient-years; HR, 0.64, 95% CI, 0.49–0.85; p=0.002) and higher risks of overall bleeding (21.59 vs 18.35 per 100 patient-years; HR, 1.16, 95% CI, 1.06–1.27; p=0.002) and Bleeding Academic Research Consortium (BARC) type 2 bleeding (18.67 vs 15.08 per 100 patient-years; HR, 1.22, 95% CI, 1.11–1.36; p<0.001) compared with clopidogrel. There were no significant differences in terms of risks of death, MI, and BARC 3 or 5 bleeding between the treatment arms. 

    In summary, ticagrelor was comparable to clopidogrel in the composite of death, MI and stroke, but had an increased risk of BARC type 2 bleeding. Overall, the study points to the beneficial role of ticagrelor in post-MI stroke prevention in East Asian patients. 

    Reference:
    Chang C-J, et al. Efficacy and safety of ticagrelor versus clopidogrel in East Asian patients with acute myocardial infarction: A nationwide cohort study. Clin Pharmacol Ther 2020. doi: 10.1002/cpt.2011. [Epub ahead of print]