Is Plavix going to be History??
Recent study by wallentin et al looked at the Ticagrelor (Brilinta®) versus Clopidogrel (Plavix) in patients with Acute Coronary Syndromes.
Ticagrelor is an oral, reversible, direct-acting inhibitor of the adenosine diphosphate receptor P2Y12 that has a more rapid onset and more pronounced platelet inhibition than clopidogrel.
They studied 18624 patients in double blind randomized trial ticagrelor (180-mg loading dose, 90 mg twice daily thereafter) and clopidogrel (300-to-600-mg loading dose, 75 mg daily thereafter) in patients admitted to the hospital with an acute coronary syndrome, with or without ST-segment elevation.
Results: At 12 months
- 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.
- Secondary end point: 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).
- Death from vascular causes (4.0% vs. 5.1%, P=0.001) but not stroke alone (1.5% vs. 1.3%, P=0.22).
- Death from any cause was also reduced with ticagrelor (4.5%, vs. 5.9% with clopidogre).
- 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: In patients who have an acute coronary syndrome with or without ST-segment elevation, treatment with ticagrelor as compared with clopidogrel significantly reduced the rate of death from vascular causes, myocardial infarction, or stroke without an increase in the rate of overall major bleeding but with an increase in the rate of non–procedure-related bleeding.
Reference:
Wallentin L, Becker RC, Budaj A, et al. Ticagrelor versus Clopidogrel in patients with Acute Coronary Syndromes. N Engl J Med 2009; www.nejm.org August 30, 2009
