Pre-admission antiplatelet therapy and treatment effect of ticagrelor vs. prasugrel in patients with acute coronary syndromes—a subgroup analysis of the ISAR-REACT 5 trial. Issue 7 (22nd February 2022)

• Record Type: Journal Article
• Authors: Lahu, Shqipdona; Ndrepepa, Gjin; Neumann, Franz-Josef; Menichelli, Maurizio; Bernlochner, Isabell; Richardt, Gert; Wöhrle, Jochen; Witzenbichler, Bernhard; Hemetsberger, Rayyan; Mayer, Katharina; Akin, Ibrahim; Cassese, Salvatore; Gewalt, Senta; Xhepa, Erion; Kufner, Sebastian; Valina, Christian; Sager, Hendrik B; Joner, Michael; Ibrahim, Tareq; Laugwitz, Karl-Ludwig; Schunkert, Heribert; Schüpke, Stefanie; Kastrati, Adnan
• Is Part Of: European heart journal. Volume 8:Issue 7(2022)
• Page Start: 687
• Page End: 694
• Publication Date: 2022-02-22
• Subjects: Acute coronary syndrome -- Aspirin -- Clopidogrel -- Percutaneous coronary intervention -- Prasugrel -- Ticagrelor; Cardiovascular pharmacology -- Periodicals; 615.71
• DOI: 10.1093/ehjcvp/pvac007
• Languages: English
• ISSNs: 2055-6837

Abstract

Abstract: Aims: To assess whether the efficacy and safety of ticagrelor vs. prasugrel in patients with acute coronary syndromes (ACSs) are influenced by pre-admission treatment with aspirin and/or clopidogrel. Methods and results: Patients ( n = 4018) were categorized into two groups: pre-admission aspirin and/or clopidogrel group ( n = 1455) and no pre-admission aspirin or clopidogrel group ( n = 2563). The primary endpoint was the composite of all-cause death, myocardial infarction, or stroke; the secondary safety endpoint was Bleeding Academic Research Consortium (BARC) type 3–5 bleeding, both at 1 year. Patients in the pre-admission aspirin and/or clopidogrel group had a higher risk of ischaemic events, but a similar risk of bleeding to patients in the no pre-admission aspirin or clopidogrel group (cumulative incidences 10.5% vs. 6.7%, and 5.7% vs. 5.7%, respectively). The primary endpoint occurred in 81/717 patients assigned to ticagrelor and 69/738 patients assigned to prasugrel in the pre-admission aspirin and/or clopidogrel group [11.5% vs. 9.5%; hazard ratio (HR) = 1.23; 95% confidence interval (CI) 0.89–1.69], and in 103/1295 patients assigned to ticagrelor and 68/1268 patients assigned to prasugrel in the no pre-admission aspirin or clopidogrel group [8.0% vs. 5.4%; HR = 1.50 (1.10–2.03); P int = 0.38]. BARC type 3–5 bleeding events did not differ between ticagrelor and prasugrel in patients in the pre-admission aspirin and/or clopidogrel (6.2% vs. 4.5%) or no pre-admission aspirin or clopidogrel (5.3% vs. 5.1%) group ( P int = 0.54). Conclusion: In patients with ACS, pre-admission therapy with aspirin and/or clopidogrel has no influence on the relative efficacy and safety of ticagrelor and prasugrel.