Comparison of ticagrelor with clopidogrel in patients with a planned invasive strategy for acute coronary syndromes (PLATO)

• Verfasst von: Cannon, Christopher P. [VerfasserIn]
• Verfasst von: Harrington, Robert A [VerfasserIn]
• Verfasst von: James, Stefan [VerfasserIn]
• Verfasst von: Ardissino, Diego [VerfasserIn]
• Verfasst von: Becker, Richard C [VerfasserIn]
• Verfasst von: Emanuelsson, Håkan [VerfasserIn]
• Verfasst von: Husted, Steen [VerfasserIn]
• Verfasst von: Katus, Hugo [VerfasserIn]
• Verfasst von: Keltai, Matyas [VerfasserIn]
• Verfasst von: Khurmi, Nardev S [VerfasserIn]
• Verfasst von: Kontny, Frederic [VerfasserIn]
• Verfasst von: Lewis, Basil S [VerfasserIn]
• Verfasst von: Steg, Philippe Gabriel [VerfasserIn]
• Verfasst von: Storey, Robert F [VerfasserIn]
• Verfasst von: Wojdyla, Daniel [VerfasserIn]
• Verfasst von: Wallentin, Lars [VerfasserIn]
• Titel: Comparison of ticagrelor with clopidogrel in patients with a planned invasive strategy for acute coronary syndromes (PLATO)
• Titelzusatz: a randomised double-blind study
• Verf.angabe: Christopher P Cannon, Robert A Harrington, Stefan James, Diego Ardissino, Richard C Becker, Håkan Emanuelsson, Steen Husted, Hugo Katus, Matyas Keltai, Nardev S Khurmi, Frederic Kontny, Basil S Lewis, Philippe Gabriel Steg, Robert F Storey, Daniel Wojdyla, Lars Wallentin for the PLATelet inhibition and patient Outcomes (PLATO) investigators
• E-Jahr: 2010
• Jahr: 13 January 2010
• Umfang: 11 S.
• Fussnoten: Gesehen am 29.03.2023
• Titel Quelle: Enthalten in: The lancet <London>
• Ort Quelle: London [u.a.] : Elsevier, 1823
• Jahr Quelle: 2010
• Band/Heft Quelle: 375(2010), 9711, Seite 283-293
• ISSN Quelle: 1474-547X
• DOI: doi:10.1016/S0140-6736(09)62191-7
• Datenträger: Online-Ressource
• Sprache: eng
• K10plus-PPN: 1840460326

Abstract

Background - Variation in and irreversibility of platelet inhibition with clopidogrel has led to controversy about its optimum dose and timing of administration in patients with acute coronary syndromes. We compared ticagrelor, a more potent reversible P2Y12 inhibitor with clopidogrel in such patients. - Methods - At randomisation, an invasive strategy was planned for 13 408 (72·0%) of 18 624 patients hospitalised for acute coronary syndromes (with or without ST elevation). In a double-blind, double-dummy study, patients were randomly assigned in a one-to-one ratio to ticagrelor and placebo (180 mg loading dose followed by 90 mg twice a day), or to clopidogrel and placebo (300-600 mg loading dose or continuation with maintenance dose followed by 75 mg per day) for 6-12 months. All patients were given aspirin. The primary composite endpoint was cardiovascular death, myocardial infarction, or stroke. Analyses were by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT00391872. - Findings - 6732 patients were assigned to ticagrelor and 6676 to clopidogrel. The primary composite endpoint occurred in fewer patients in the ticagrelor group than in the clopidogrel group (569 [event rate at 360 days 9·0%] vs 668 [10·7%], hazard ratio 0·84, 95% CI 0·75-0·94; p=0·0025). There was no difference between clopidogrel and ticagrelor groups in the rates of total major bleeding (691 [11·6%] vs 689 [11·5%], 0·99 [0·89-1·10]; p=0·8803) or severe bleeding, as defined according to the Global Use of Strategies To Open occluded coronary arteries, (198 [3·2%] vs 185 [2·9%], 0·91 [0·74-1·12]; p=0·3785). - Interpretation - Ticagrelor seems to be a better option than clopidogrel for patients with acute coronary syndromes for whom an early invasive strategy is planned. - Funding - AstraZeneca.