Question In patients with ST-elevation myocardial infarction treated with fibrinolytic therapy, is ticagrelor noninferior to clopidogrel with respect to thrombolysis in myocardial infarction major bleeding at 30 days?
Findings In this randomized clinical trial of 3799 patients, delayed administration of ticagrelor after fibrinolytic therapy was noninferior to clopidogrel for thrombolysis in myocardial infarction major bleeding at 30 days. However, minor bleeding was increased with ticagrelor and there was no benefit on efficacy outcomes.
Meaning Because most of the included patients were pretreated with clopidogrel, these findings reflect mostly the noninferiority of switching from clopidogrel to ticagrelor in patients already fully loaded with clopidogrel.
Importance The bleeding safety of ticagrelor in patients with ST-elevation myocardial infarction treated with fibrinolytic therapy remains uncertain.
Objective To evaluate the short-term safety of ticagrelor when compared with clopidogrel in patients with ST-elevation myocardial infarction treated with fibrinolytic therapy.
Design, Setting and Participants We conducted a multicenter, randomized, open-label with blinded end point adjudication trial that enrolled 3799 patients (younger than 75 years) with ST-segment elevation myocardial infarction receiving fibrinolytic therapy in 152 sites from 10 countries from November 2015 through November 2017. The prespecified upper boundary for noninferiority for bleeding was an absolute margin of 1.0%.
Interventions Patients were randomized to ticagrelor (180-mg loading dose, 90 mg twice daily thereafter) or clopidogrel (300-mg to 600-mg loading dose, 75 mg daily thereafter). Patients were randomized with a median of 11.4 hours after fibrinolysis, and 90% were pretreated with clopidogrel.
Main Outcomes and Measures The primary outcome was thrombolysis in myocardial infarction (TIMI) major bleeding through 30 days.
Results The mean (SD) age was 58.0 (9.5) years, 2928 of 3799 patients (77.1%) were men, and 2177 of 3799 patients (57.3%) were white. At 30 days, TIMI major bleeding had occurred in 14 of 1913 patients (0.73%) receiving ticagrelor and in 13 of 1886 patients (0.69%) receiving clopidogrel (absolute difference, 0.04%; 95% CI, 0.49% to 0.58%; P<.001 for noninferiority). Major bleeding defined by the Platelet Inhibition and Patient Outcomes criteria and by the Bleeding Academic Research Consortium types 3 to 5 bleeding occurred in 23 patients (1.20%) in the ticagrelor group and in 26 patients (1.38%) in the clopidogrel group (absolute difference, 0.18%; 95% CI, 0.89% to 0.54; P=.001 for noninferiority). The rates of fatal (0.16% vs 0.11%; P=.67) and intracranial bleeding (0.42% vs 0.37%; P=.82) were similar between the ticagrelor and clopidogrel groups, respectively. Minor and minimal bleeding were more common with ticagrelor than with clopidogrel. The composite of death from vascular causes, myocardial infarction, or stroke occurred in 76 patients (4.0%) treated with ticagrelor and in 82 patients (4.3%) receiving clopidogrel (hazard ratio, 0.91; 95% CI, 0.67-1.25; P=.57).
Conclusions and Relevance In patients younger than 75 years with ST-segment elevation myocardial infarction, delayed administration of ticagrelor after fibrinolytic therapy was noninferior to clopidogrel for TIMI major bleeding at 30 days.
Trial Registration clinicaltrials.gov Identifier: NCT02298088.
Follow this link:
Ticagrelor vs Clopidogrel After Fibrinolytic Therapy in ...
- Jake Diekman throws BP session for Rangers | MLB.com - MLB.com - August 6th, 2017 [August 6th, 2017]
- Cerebral palsy: Symptoms, diagnosis, treatment - December 5th, 2017 [December 5th, 2017]
- Hypothalamus - the body's thermostat | ASU - Ask A Biologist - December 6th, 2017 [December 6th, 2017]
- When Stroke Affects the Thalamus - Stroke Connection ... - December 28th, 2017 [December 28th, 2017]
- The Endocrine System: Hypothalamus and Pituitary - December 28th, 2017 [December 28th, 2017]
- Hypothalamus - Anatomy, Blood supply and Function | Kenhub - December 28th, 2017 [December 28th, 2017]
- Ulcerative Colitis - Cedars-Sinai - January 6th, 2018 [January 6th, 2018]
- Ulcerative colitis - Treatment - NHS.UK - January 7th, 2018 [January 7th, 2018]
- Business Directory | Uptown Waterloo Business Improvement Area - January 8th, 2018 [January 8th, 2018]
- Will States Continue To Fund Stem Cell Research? : Shots ... - January 28th, 2018 [January 28th, 2018]
- Spinal Cord Injuries - emedicine.medscape.com - February 15th, 2018 [February 15th, 2018]
- Spinal Cord Injuries - spine.org - February 15th, 2018 [February 15th, 2018]
- Journal of Clinical & Experimental Cardiology - Open Access Journals - April 10th, 2018 [April 10th, 2018]
- Cardiology Treatment - Fortis Healthcare - April 10th, 2018 [April 10th, 2018]
- Biology Junction - April 12th, 2018 [April 12th, 2018]
- Managing Right Ventricular Failure in PAH: An Algorithmic ... - April 14th, 2018 [April 14th, 2018]
- Cardiovascular Pharmacotherapeutics: William H. Frishman ... - May 13th, 2018 [May 13th, 2018]
- 13 Super Foods Good for Eczema - Top Eczema Treatments - May 15th, 2018 [May 15th, 2018]
- Diagnosis & Treatment of Parkinson's - ParkinsonsDisease.net - May 30th, 2018 [May 30th, 2018]
- Arizona Heart Rhythm Center - June 10th, 2018 [June 10th, 2018]
- Ayurvedic Medicines for Ulcerative Colitis | Natural ... - June 21st, 2018 [June 21st, 2018]
- Weinstein Cardiovascular Development and Regeneration Meeting - June 30th, 2018 [June 30th, 2018]
- Ulcerative Colitis Information Centre - July 31st, 2018 [July 31st, 2018]
- Sudden Death in Dogs - Pet Health Network | Pet Health ... - August 7th, 2018 [August 7th, 2018]
- Coronary Heart Disease - Ischaemic heart disease - British ... - August 21st, 2018 [August 21st, 2018]
- Cardiac Rehabilitation: Overview, History and Definition ... - August 25th, 2018 [August 25th, 2018]
- Difference between Cardiac Arrest and Respiratory Arrest ... - August 25th, 2018 [August 25th, 2018]
- ECM for Pericardial Closure - Aziyo - August 25th, 2018 [August 25th, 2018]
- Adult Mental Health | Georgia Department of Behavioral Health ... - September 6th, 2018 [September 6th, 2018]
- Mental Health | ECLKC - September 6th, 2018 [September 6th, 2018]
- Mental Health - The Church of Jesus Christ of Latter-day Saints - September 6th, 2018 [September 6th, 2018]
- Center for Vascular Biology - Home | UConn Health - September 22nd, 2018 [September 22nd, 2018]
- # Diabetes Stem Cell Research Diabetes Care Measures - September 30th, 2018 [September 30th, 2018]
- Cardiac Rhythm Disturbances | The Patient Guide to Heart ... - November 2nd, 2018 [November 2nd, 2018]
- Arrhythmia | Cleveland Clinic - November 2nd, 2018 [November 2nd, 2018]
- Hyperbaric Oxygen Therapy for Wound Healing | Johns ... - November 13th, 2018 [November 13th, 2018]
- NIMH Home - November 24th, 2018 [November 24th, 2018]
- What is an interventional cardiologist? | Heart Surgeries ... - November 26th, 2018 [November 26th, 2018]
- Molecular Cardiology Research Institute Boston | Tufts ... - November 29th, 2018 [November 29th, 2018]
- Lower vascular plant | botany | Britannica.com - December 7th, 2018 [December 7th, 2018]
- Welcome to the ABG Tutorial Welcome to Hansen - December 12th, 2018 [December 12th, 2018]
- Cardiac catheterization - Wikipedia - December 12th, 2018 [December 12th, 2018]
- Stem Cell Research & Therapy | Home page - December 22nd, 2018 [December 22nd, 2018]
- Journal of Stem Cell Research and Therapy- Open Access ... - December 22nd, 2018 [December 22nd, 2018]
- Stem-cell therapy - Wikipedia - December 22nd, 2018 [December 22nd, 2018]
- Cardiology and Interventional Cardiology - December 23rd, 2018 [December 23rd, 2018]
- Rhode Island Interventional Cardiology | Cardiovascular ... - December 23rd, 2018 [December 23rd, 2018]
- Interventional Cardiology Certification Policies | ABIM.org - December 23rd, 2018 [December 23rd, 2018]
- Interventional Cardiology - Boston Scientific - December 23rd, 2018 [December 23rd, 2018]
- 9 Benefits of Human Growth Hormone (Along with Side ... - December 27th, 2018 [December 27th, 2018]
- Growth hormone deficiency - Wikipedia - December 27th, 2018 [December 27th, 2018]
- Dr. Lorrie Kirshenbaum, Cardiac Gene Biology | St ... - January 28th, 2019 [January 28th, 2019]
- Cardiomyopathy - CardioSmart - February 8th, 2019 [February 8th, 2019]
- Centenary Institute | Medical Research, Life Saving Research - February 24th, 2019 [February 24th, 2019]
- Cardiovascular Medicine | Department of Medicine - March 29th, 2019 [March 29th, 2019]
- Rapid Test Market 2019 with Recent Trends, Revenue, Demand and Top Manufactures- Bureau Veritas, SGS SA, Intertek Group plc, Eurofins Scientific -... - October 11th, 2019 [October 11th, 2019]
- Medical Imaging Equipment Market Research Report 2019: Global Industry Analysis, Business Development, Size, Share, Trends, Future Growth, Forecast To... - October 11th, 2019 [October 11th, 2019]
- Analysis on the Global DNA Read, Write & Edit Market, 2017-2019 and Forecast to 2024 - Yahoo Finance - October 11th, 2019 [October 11th, 2019]
- Cardiac Surgery Instruments Market is Expected to Tread a Steady Growth Trajectory by Clocking a CAGR of 5.9% from 2017 to 2022 - Health News Office - October 24th, 2019 [October 24th, 2019]
- PEDIATRIC MEDICAL DEVICES MARKET IS PROJECTED TO EXPAND AT A CAGR OF 8.0% FROM 2018 TO 2026 - Health News Office - November 1st, 2019 [November 1st, 2019]
- myTAIHEART Test Provides Evidence for Injury from Biopsy of Heart Transplant Recipients Cardiology2.0 - Cardiology2.0 - November 1st, 2019 [November 1st, 2019]
- Mental health and your heart - British Heart Foundation - November 19th, 2019 [November 19th, 2019]
- BUZZ-U.S. STOCKS ON THE MOVE-Cango, Gulfport Energy, Abiomed, Standard Diversified, Wanda Sports, Eidos - Nasdaq - November 19th, 2019 [November 19th, 2019]
- Cost Analysis of COPD Exacerbations and Cardiovascular Events in SUMMIT - AJMC.com Managed Markets Network - November 19th, 2019 [November 19th, 2019]
- Hundreds walk to defeat ALS in Ancient City - St. Augustine Record - November 22nd, 2019 [November 22nd, 2019]
- Living with Lung Cancer: The Silver Linings - Curetoday.com - November 22nd, 2019 [November 22nd, 2019]
- Building the human spinal cord atlas - SynBioBeta - November 22nd, 2019 [November 22nd, 2019]
- The Week That Wasn't: Keto and the Flu, Human Cyborg, Duvet Disease - Medscape - November 22nd, 2019 [November 22nd, 2019]
- ALS advance offers hope for those diagnosed with deadly disease - WRAL.com - November 22nd, 2019 [November 22nd, 2019]
- ALS Stem Cell Therapy Developer Seeks Amendment to its AstroRx Trial - ALS News Today - November 22nd, 2019 [November 22nd, 2019]
- Former Boston Globe writer, current NHL executive Snow diagnosed with ALS | College Hockey - USCHO - December 23rd, 2019 [December 23rd, 2019]
- AB Science announces the publication of new results in the peer-reviewed journal Glia that further support masitinib's potential mode of action in ALS... - December 23rd, 2019 [December 23rd, 2019]
- Christmas in the City thrills homeless families, takes on poignancy with founders ALS diagnosis - The Boston Globe - December 23rd, 2019 [December 23rd, 2019]
- Amylyx Pharmaceuticals Announces AMX0035 Demonstrated Statistically Significant Treatment Benefit for People with ALS in the CENTAUR Trial - Business... - December 23rd, 2019 [December 23rd, 2019]
- RADICAVA (edaravone) - December 23rd, 2019 [December 23rd, 2019]
- List of Amyotrophic Lateral Sclerosis Medications (5 Compared ... - December 23rd, 2019 [December 23rd, 2019]
- Neuropore Completes Phase 1 Clinical Trial in Healthy Volunteers with NPT520-34, a Therapeutic Candidate Aimed at Treating Parkinson's Disease and... - January 14th, 2020 [January 14th, 2020]
- Comprehensive Analysis on Prostacyclin Market based on types and application - Technology Magazine - January 18th, 2020 [January 18th, 2020]
- N.J. karate legend who inspired thousands loses battle with ALS - NJ.com - January 18th, 2020 [January 18th, 2020]
- Denali Therapeutics Announces Broad Pipeline Progress Including Positive Results From Its LRRK2 Program for Parkinson's Disease - Associated Press - January 18th, 2020 [January 18th, 2020]