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2017 ; 8
(3
): 105-110
Nephropedia Template TP
gab.com Text
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English Wikipedia
Comparison of Clopidogrel With Prasugrel and Ticagrelor in Patients With Acute
Coronary Syndrome: Clinical Outcomes From the National Cardiovascular Database
ACTION Registry
#MMPMID28725326
Khayata M
; Gabra JN
; Nasser MF
; Litman GI
; Bhakta S
; Raina R
Cardiol Res
2017[Jun]; 8
(3
): 105-110
PMID28725326
show ga
BACKGROUND: We aimed to compare the clinical outcomes of clopidogrel, prasugrel,
and ticagrelor in clinical practice using the National Cardiovascular Database
ACTION Registry(®). Treatment guidelines for patients with acute coronary
syndrome (ACS) undergoing percutaneous coronary intervention recommend dual
antiplatelet therapy (DAPT) for 12 months. Few clinical trials have compared the
safety and efficacy of clopidogrel with that of newer antiplatelet therapies.
METHODS: A retrospective study of patients hospitalized for ACS at Cleveland
Clinic Akron General was conducted. Data elements included detailed medical
history and clinical outcomes during hospital stay. The primary outcome was a
composite of major clinical events (cardiogenic shock, atrial fibrillation,
ventricular fibrillation, ventricular tachycardia, heart failure, bleeding, and
mechanical ventilation). The independent variable was the type of DAPT.
Statistical analyses were performed using Chi-square and Mann-Whitney U tests. A
post-hoc analysis was performed to compare between the antiplatelet drugs
head-to-head. RESULTS: Subjects (n = 1,388) admitted between January 2011 and
March 2016 with ACS and treated with clopidogrel, prasugrel, or ticagrelor were
included in the study. Mean age was 65 ± 14 years and 46% had ST-segment
elevation myocardial infarction. Prasugrel administration within 24 h was
associated with a lower incidence of the composite outcome (P = 0.049), bleeding
(P = 0.028), and heart failure (P = 0.002). CONCLUSION: There was a significant
difference between the type of antiplatelet drug and clinical outcomes in ACS
patients who were treated with DAPT. Observations from current study may provide
important information for prescribers in clinical decision-making.