Volume : 09, Issue : 05, May – 2022
Title:
40.THE COMPARISON OF EFFICACY AND SAFETY OF TICAGRELOR VERSUS CLOPIDOGREL IN THE MANAGEMENT OF ACUTE CORONARY SYNDROME: A SYSTEMATIC REVIEW
Authors :
Sami Ullah, Hammad Sharif, Madeeha Khaleeque, Muhammad Hassan Jan, Atif Ahmed, Muhammad Abdur Rauf, Irfan Ali khan
Abstract :
Dual antiplatelet therapy (DAPT) forms the main pillar of the medical management of acute coronary syndrome (ACS). Historically clopidogrel has been in use as part of DAPT but recent evidence has shown that it has a slow onset of action and less potent antiplatelet efficacy which has lead to cases of myocardial infarction and stent thrombosis. As a consequence, it has lead to the development of newer P2Y12 receptor antagonists like ticagrelor and prasugrel. Ticagrelor has a rapid onset of action and more potent platelet inhibition quality which has resulted in better cardiovascular outcomes in patients of ACS. We have conducted a systematic review to retrieve clinical evidence regarding the efficacy and safety profile of ticagrelor versus clopidogrel and it has shown that ticagrelor has demonstrated superiority in terms of its efficacy and safety profile as compared to clopidogrel. Such an analysis has got great clinical implications on the future of management of ACS patients as stent thrombosis and myocardial infarction, which occurs due to inadequate platelet inhibition, form the major morbidity and mortality in patients experiencing an episode of ACS. Hence the choice of a drug that has got potent antiplatelet activity, not at the expense of major bleeding, will drastically improve the prognosis of ACS patients.
Keywords: Ticagrelor, Clopidogrel. Acute Coronary Syndrome, Bleeding, Efficacy, Cardiovascular outcomes
Cite This Article:
Please cite this article in press Sami Ullah et al, The Comparison Of Efficacy And Safety Of Ticagrelor Versus Clopidogrel In The Management of Acute coronary syndrome: A Systematic Review., Indo Am. J. P. Sci, 2022; 09(5).,
Number of Downloads : 10
References:
1. Matetzky S, Shenkman B, Guetta V, Shechter M, Beinart R, Goldenberg I et al. Clopidogrel Resistance Is Associated With Increased Risk of Recurrent Atherothrombotic Events in Patients With Acute Myocardial Infarction. Circulation. 2004;109(25):3171-3175. 10.1161/01.CIR.0000130846.46168.03
2. Gurbel P, Bliden K, Hiatt B, O’Connor C. Clopidogrel for Coronary Stenting. Circulation. 2003;107(23):2908-2913. 10.1161/01.CIR.0000072771.11429.83
3. Fox K, Mehta S, Peters R, Zhao F, Lakkis N, Gersh B et al. Benefits and Risks of the Combination of Clopidogrel and Aspirin in Patients Undergoing Surgical Revascularization for Non–ST-Elevation Acute Coronary Syndrome. Circulation. 2004;110(10):1202-1208. 10.1161/01.CIR.0000140675.85342.1B
4. Kuliczkowski W, Witkowski A, Polonski L, Watala C, Filipiak K, Budaj A et al. Interindividual variability in the response to oral antiplatelet drugs: a position paper of the Working Group on antiplatelet drugs resistance appointed by the Section of Cardiovascular Interventions of the Polish Cardiac Society, endorsed by the Working Group on Thrombosis of the European Society of Cardiology. Eur Heart J. 2008;30(4):426-435. 10.1093/eurheartj/ehn562
5. Storey R, Husted S, Harrington R, Heptinstall S, Wilcox R, Peters G et al. Inhibition of Platelet Aggregation by AZD6140, A Reversible Oral P2Y12Receptor Antagonist, Compared With Clopidogrel in Patients With Acute Coronary Syndromes. JACC. 2007;50(19):1852-1856. 10.1016/j.jacc.2007.07.058
6. Husted S, Emanuelsson H, Heptinstall S, Sandset P, Wickens M, Peters G. Pharmacodynamics, pharmacokinetics, and safety of the oral reversible P2Y12 antagonist AZD6140 with aspirin in patients with atherosclerosis: a double-blind comparison to clopidogrel with aspirin. Eur Heart J. 2006;27(9):1038-1047. 10.1093/eurheartj/ehi754
7. Husted S, James S, Bach R, Becker R, Budaj A, Heras M et al. The efficacy of ticagrelor is maintained in women with acute coronary syndromes participating in the prospective, randomized, PLATelet inhibition and patient Outcomes (PLATO) trial. Eur Heart J. 2014;35(23):1541-1550. 10.1093/eurheartj/ehu075
8. Goto S, Huang C, Park S, Emanuelsson H, Kimura T. Ticagrelor vs. Clopidogrel in Japanese, Korean and Taiwanese Patients With Acute Coronary Syndrome – Randomized, Double-Blind, Phase III PHILO Study –. Circulation Journal. 2015;79(11):2452-2460. 10.1253/circj.CJ-15-0112
9. Lindholm D, Varenhorst C, Cannon C, Harrington R, Himmelmann A, Maya J et al. Ticagrelor vs. clopidogrel in patients with non-ST-elevation acute coronary syndrome with or without revascularization: results from the PLATO trial. Eur Heart J. 2014;35(31):2083-2093. 10.1093/eurheartj/ehu160
10. Hamilos M, Kanakakis J, Anastasiou I, Karvounis C, Vasilikos V, Goudevenos J et al. Ticagrelor versus clopidogrel in patients with STEMI treated with thrombolysis: the MIRTOS trial. EuroIntervention. 2021;16(14):1163-1169. 10.4244/EIJ-D-20-00268
11. Li X, Su G, Wang G, Hu H, Fan C. Switching from ticagrelor to clopidogrel in patients with ST-segment elevation myocardial infarction undergoing successful percutaneous coronary intervention in real-world China: Occurrences, reasons, and long-term clinical outcomes. Clin Cardiol. 2018;41(11):1446-1454. 10.1002/clc.23074
12. De Berardis G, Sacco M, Strippoli G, Pellegrini F, Graziano G, Tognoni G et al. Aspirin for primary prevention of cardiovascular events in people with diabetes: meta-analysis of randomised controlled trials. BMJ. 2009;339(nov06 1):b4531-b4531. 10.1136/bmj.b4531
13. Tan Q, Jiang X, Huang S, Zhang T, Chen L, Xie S et al. The clinical efficacy and safety evaluation of ticagrelor for acute coronary syndrome in general ACS patients and diabetic patients: A systematic review and meta-analysis. PLOS ONE. 2017;12(5):e0177872. 10.1371/journal.pone.0177872
14. Dai W, Ye Z, Li L, Su Q. Effect of preoperative loading dose ticagrelor and clopidogrel on no-reflow phenomenon during intervention in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention: a systematic review and meta-analysis. Drug Des Devel Ther. 2018;Volume 12:2039-2049. 10.2147/DDDT.S165431
15. Rohman M, Purnamasari Y, Ilmawan M, Mahdi B, Tamara F, Mahendra A et al. Comparison of major bleeding in patients with acute coronary syndrome that underwent coronary artery bypass grafting treated with clopidogrel or ticagrelor: a systematic review and meta-analysis. F1000Res. 2020;9:99. 10.12688/f1000research.21925.2
16. Pelletier‐Galarneau M, Hunter C, Ascah K, Beanlands R, Dwivedi G, deKemp R et al. Randomized Trial Comparing the Effects of Ticagrelor Versus Clopidogrel on Myocardial Perfusion in Patients With Coronary Artery Disease. J Am Heart Assoc. 2017;6(5). 10.1161/JAHA.117.005894
17. Angiolillo D, Franchi F, Waksman R, Sweeny J, Raveendran G, Teng R et al. Effects of Ticagrelor Versus Clopidogrel in Troponin-Negative Patients With Low-Risk ACS Undergoing Ad Hoc PCI. JACC. 2016;67(6):603-613. 10.1016/j.jacc.2015.11.044
18. Campo G, Dalla Sega F, Pavasini R, Aquila G, Gallo F, Fortini F et al. Biological effects of ticagrelor over clopidogrel in patients with stable coronary artery disease and chronic obstructive pulmonary disease. Thromb Haemost. 2017;117(06):1208-1216. 10.1160/TH16-12-0973