Outcome of Ticagrelor Versus Clopidogrel in ACS Patients Undergoing PCI
DOI:
https://doi.org/10.70749/ijbr.v2i02.251Keywords:
Ticagrelor, Clopidogrel, Acute Coronary Syndrome, PCI, MACEAbstract
Objective: To compare the efficacy and safety of ticagrelor versus clopidogrel in reducing major adverse cardiovascular events (MACE) and managing bleeding risks in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) at Pakistan Atomic Energy Commission of Pakistan. Methodology: This prospective, randomized study included 400 ACS patients undergoing PCI from January 2023 to August 2024. Patients were divided into two groups, receiving either ticagrelor (n=200) or clopidogrel (n=200), with outcomes assessed at 30 days. The primary outcome was the occurrence of MACE, and secondary outcomes included minor bleeding events and stent thrombosis rates. Data were analyzed using chi-square tests to compare efficacy and safety between groups. Results: Ticagrelor showed a slightly lower rate of MACE (49%) compared to clopidogrel (55%), suggesting enhanced efficacy in reducing ischemic events. However, ticagrelor also had a higher incidence of minor bleeding events (56.5% vs. 47% in the clopidogrel group), underscoring the need for careful patient selection due to increased bleeding risks. Stent thrombosis rates did not differ significantly between the groups. Conclusion: Ticagrelor provides a beneficial alternative to clopidogrel for preventing ischemic events in ACS patients undergoing PCI. However, due to its higher bleeding risk, individualized patient assessment is crucial to optimizing outcomes. These findings contribute essential evidence to guide antiplatelet therapy in the Pakistani context.
References
Peyracchia, M., Saglietto, A., Biolè, C., Raposeiras-Roubin, S., Abu-Assi, E., Kinnaird, T., Ariza-Solé, A., Liebetrau, C., Manzano-Fernández, S., Boccuzzi, G., Henriques, J. P. S., Wilton, S. B., Velicki, L., Xanthopoulou, I., Correia, L., Rognoni, A., Fabrizio, U., Nuñez-Gil, I., Montabone, A., & Taha, S. (2019). Efficacy and Safety of Clopidogrel, Prasugrel and Ticagrelor in ACS Patients Treated with PCI: A Propensity Score Analysis of the RENAMI and BleeMACS Registries. American Journal of Cardiovascular Drugs, 20(3), 259–269. https://doi.org/10.1007/s40256-019-00373-1
Mohareb, M. W., AbdElghany, M., Zaki, H. F., & El-Abhar, H. S. (2020). Diabetes and CYP2C19 Polymorphism Synergistically Impair the Antiplatelet Activity of Clopidogrel Compared With Ticagrelor in Percutaneous Coronary Intervention–treated Acute Coronary Syndrome Patients. Journal of Cardiovascular Pharmacology, 76(4), 478–488. https://doi.org/10.1097/fjc.0000000000000881
Ishaq, M., Ashraf, N., Chand, G., Shahzad Khatti, Mueed, A., & Raheem, A. (2023). Ticagrelor versus Clopidogrel, Drug of Choice for the Prevention of Stent Thrombosis after Percutaneous Coronary Intervention: A Meta-Analysis of Randomized Controlled Trials. Pakistan Heart Journal, 56(2), 140–145. https://doi.org/10.47144/phj.v56i2.2520
Silvain, J., Lattuca, B., Beygui, F., Rangé, G., Motovska, Z., Dillinger, J.-G., Boueri, Z., Brunel, P., Lhermusier, T., Pouillot, C., Larrieu-Ardilouze, E., Boccara, F., Labeque, J.-N., Guedeney, P., El Kasty, M., Laredo, M., Dumaine, R., Ducrocq, G., Collet, J.-P., & Cayla, G. (2020). Ticagrelor versus clopidogrel in elective percutaneous coronary intervention (ALPHEUS): a randomised, open-label, phase 3b trial. The Lancet, 396(10264), 1737–1744. https://doi.org/10.1016/s0140-6736(20)32236-4
Peng, W., Zhang, Y., Li, X., & Lin, Y. (2022). Efficacy and safety of clopidogrel versus ticagrelor for stabilized patients with acute coronary syndromes after percutaneous coronary intervention: results from a real-world registry in China. Journal of Cardiovascular Pharmacology, 81(2), 134–140. https://doi.org/10.1097/fjc.0000000000001381
chen, yundai, Wang, D., Li, D., Sun, Y., Ye, X., & Li, L. (2020). Abstract 15223: Comparison of Net Clinical Benefit Between Clopidogrel-based and Ticagrelor-based Dual Antiplatelet Therapy in Acute Coronary Syndrome Patients Undergoing Percutaneous Coronary Intervention in China. Circulation, 142(Suppl_3). https://doi.org/10.1161/circ.142.suppl_3.15223
Na, K., Li, M. Y., Qiu, M. H., Li, J., Liu, R., Li, Y., & Han, Y. L. (2021). [The efficacy and safety of ticagrelor versus clopidogrel in elderly patients with acute coronary syndrome undergoing percutaneous coronary intervention]. PubMed, 49(11), 1117–1123. https://doi.org/10.3760/cma.j.cn112148-20201127-00943
Sun, M., Cui, W., & Li, L. (2022). Comparison of Clinical Outcomes Between Ticagrelor and Clopidogrel in Acute Coronary Syndrome: A Comprehensive Meta-Analysis. Frontiers in Cardiovascular Medicine, 8. https://doi.org/10.3389/fcvm.2021.818215
Bianco, M., Careggio, A., Biolè, C. A., Quadri, G., Quiros, A., Raposeiras-Roubin, S., Abu-Assi, E., Kinnaird, T., Ariza-Solè, A., Liebetrau, C., Manzano-Fernàndez, S., Boccuzzi, G., Jose, Spirito, A., Templin, C., Wilton, S. B., Velicki, L., Correia, L., Rognoni, A., & Ugo, F. (2021). Ticagrelor or Clopidogrel After an Acute Coronary Syndrome in the Elderly: A Propensity Score Matching Analysis from 16,653 Patients Treated with PCI Included in Two Large Multinational Registries. Cardiovascular Drugs and Therapy, 35(6), 1171–1182. https://doi.org/10.1007/s10557-021-07213-y
Wallentin, L., Becker, R. C., Budaj, A., Cannon, C. P., Emanuelsson, H., Held, C., Horrow, J., Husted, S., James, S., Katus, H., Mahaffey, K. W., Scirica, B. M., Skene, A., Steg, P. G., Storey, R. F., & Harrington, R. A. (2009). Ticagrelor versus Clopidogrel in Patients with Acute Coronary Syndromes. New England Journal of Medicine, 361(11), 1045–1057. https://doi.org/10.1056/nejmoa0904327
Maqbool, S., Ali, M. S., Rehman, A., Rehman, M. E. U., Iqbal, J., Razzaq, A., Kamal, A., Shivamadhu, S. S., Afzal, M., Fazal, F., Basit, J., Khalid, S. A., Maqbool, S., Ali, M. S., Rehman, A., Rehman, M. E. U., Iqbal, J., Razzaq, A., Kamal, A., & Shivamadhu, S. (2023). Efficacy and Safety Profile of Ticagrelor Versus Clopidogrel in Percutaneous Coronary Intervention (PCI) for Acute Coronary Syndrome (ACS): A Systematic Review and Meta-Analysis. Cureus, 15(10). https://doi.org/10.7759/cureus.46455
Li, J., Wang, Q., Wu, C., Qu, X., Zhang, L., He, X., Ma, S., Qiu, M., & Wang, X. (2023). Safety and Efficacy of Ticagrelor versus Clopidogrel in East Asian Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention Treated with Dual Antiplatelet Therapy: A Meta-Analysis of Randomized Controlled Trials. Cardiology, 148(4), 363–373. https://doi.org/10.1159/000530602
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