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Comparison between ticagrelor and clopidogrel in myocardial infarction patients with high bleeding risk

Tjerkaski, Jonathan ; Jernberg, Tomas ; Alfredsson, Joakim ; Erlinge, David LU orcid ; James, Stefan ; Lindahl, Bertil ; Mohammad, Moman Aladdin LU ; Omerovic, Elmir ; Venetsanos, Dimitrios and Szummer, Karolina (2023) In European Heart Journal - Cardiovascular Pharmacotherapy 9(7). p.627-635
Abstract

Aims Ticagrelor is associated with a lower risk of ischemic events than clopidogrel. However, it is uncertain whether the benefits of more intensive anti-ischemic therapy outweigh the risks of major bleeding in patients who have a high bleeding risk (HBR). Therefore, this study compared ticagrelor and clopidogrel in myocardial infarction (MI) patients with HBR. Methods and results This study included all patients enrolled in the SWEDEHEART registry who were discharged with dual antiplatelet therapy using ticagrelor or clopidogrel following MI between 2010 and 2017. High bleeding risk was defined as a PRECISE-DAPT score ≥25. Information on ischemic events, major bleeding, and mortality was obtained from national registries, with 365 days... (More)

Aims Ticagrelor is associated with a lower risk of ischemic events than clopidogrel. However, it is uncertain whether the benefits of more intensive anti-ischemic therapy outweigh the risks of major bleeding in patients who have a high bleeding risk (HBR). Therefore, this study compared ticagrelor and clopidogrel in myocardial infarction (MI) patients with HBR. Methods and results This study included all patients enrolled in the SWEDEHEART registry who were discharged with dual antiplatelet therapy using ticagrelor or clopidogrel following MI between 2010 and 2017. High bleeding risk was defined as a PRECISE-DAPT score ≥25. Information on ischemic events, major bleeding, and mortality was obtained from national registries, with 365 days of follow-up. Additional outcomes include major adverse cardiovascular events (MACE), a composite of MI, stroke and all-cause mortality, and net adverse clinical events (NACE), a composite of MACE and bleeding. This study included 25 042 HBR patients, of whom 11 848 were treated with ticagrelor. Ticagrelor was associated with a lower risk of MI, stroke, and MACE, but a higher risk of bleeding compared to clopidogrel. There were no significant differences in mortality and NACE. Additionally, when examining the relationship between antiplatelet therapy and bleeding risk in 69 040 MI patients, we found no statistically significant interactions between the PRECISE-DAPT score and treatment effect. Conclusions We observed no difference in NACE when comparing ticagrelor and clopidogrel in HBR patients. Moreover, we found no statistically significant interactions between bleeding risk and the comparative effectiveness of clopidogrel and ticagrelor in a larger population of MI patients.

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author
; ; ; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Dual antiplatelet therapy, Major bleeding, Myocardial infarction, Risk score
in
European Heart Journal - Cardiovascular Pharmacotherapy
volume
9
issue
7
pages
9 pages
publisher
Oxford University Press
external identifiers
  • pmid:37263787
  • scopus:85176508279
ISSN
2055-6837
DOI
10.1093/ehjcvp/pvad041
language
English
LU publication?
yes
additional info
Funding Information: K.S. research time is funded by the Stockholm County council. Publisher Copyright: © The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.
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5ec319d1-c5dd-4ffe-9912-281597d2569e
date added to LUP
2024-01-02 12:36:05
date last changed
2024-04-17 12:36:16
@article{5ec319d1-c5dd-4ffe-9912-281597d2569e,
  abstract     = {{<p>Aims Ticagrelor is associated with a lower risk of ischemic events than clopidogrel. However, it is uncertain whether the benefits of more intensive anti-ischemic therapy outweigh the risks of major bleeding in patients who have a high bleeding risk (HBR). Therefore, this study compared ticagrelor and clopidogrel in myocardial infarction (MI) patients with HBR. Methods and results This study included all patients enrolled in the SWEDEHEART registry who were discharged with dual antiplatelet therapy using ticagrelor or clopidogrel following MI between 2010 and 2017. High bleeding risk was defined as a PRECISE-DAPT score ≥25. Information on ischemic events, major bleeding, and mortality was obtained from national registries, with 365 days of follow-up. Additional outcomes include major adverse cardiovascular events (MACE), a composite of MI, stroke and all-cause mortality, and net adverse clinical events (NACE), a composite of MACE and bleeding. This study included 25 042 HBR patients, of whom 11 848 were treated with ticagrelor. Ticagrelor was associated with a lower risk of MI, stroke, and MACE, but a higher risk of bleeding compared to clopidogrel. There were no significant differences in mortality and NACE. Additionally, when examining the relationship between antiplatelet therapy and bleeding risk in 69 040 MI patients, we found no statistically significant interactions between the PRECISE-DAPT score and treatment effect. Conclusions We observed no difference in NACE when comparing ticagrelor and clopidogrel in HBR patients. Moreover, we found no statistically significant interactions between bleeding risk and the comparative effectiveness of clopidogrel and ticagrelor in a larger population of MI patients.</p>}},
  author       = {{Tjerkaski, Jonathan and Jernberg, Tomas and Alfredsson, Joakim and Erlinge, David and James, Stefan and Lindahl, Bertil and Mohammad, Moman Aladdin and Omerovic, Elmir and Venetsanos, Dimitrios and Szummer, Karolina}},
  issn         = {{2055-6837}},
  keywords     = {{Dual antiplatelet therapy; Major bleeding; Myocardial infarction; Risk score}},
  language     = {{eng}},
  month        = {{11}},
  number       = {{7}},
  pages        = {{627--635}},
  publisher    = {{Oxford University Press}},
  series       = {{European Heart Journal - Cardiovascular Pharmacotherapy}},
  title        = {{Comparison between ticagrelor and clopidogrel in myocardial infarction patients with high bleeding risk}},
  url          = {{http://dx.doi.org/10.1093/ehjcvp/pvad041}},
  doi          = {{10.1093/ehjcvp/pvad041}},
  volume       = {{9}},
  year         = {{2023}},
}