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P2Y12 Inhibitor Monotherapy with Clopidogrel versus Ticagrelor in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention
Background: P2Y12 inhibitor monotherapy is an alternative antiplatelet strategy in patients undergoing percutaneous coronary intervention (PCI). However, the ideal P2Y12 inhibitor for monotherapy is unclear. Methods and Results: We performed a multicenter, retrospective, observational study to compa...
Autores principales: | , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7355760/ https://www.ncbi.nlm.nih.gov/pubmed/32492818 http://dx.doi.org/10.3390/jcm9061657 |
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author | Chen, Po-Wei Feng, Wen-Han Ho, Ming-Yun Su, Chun-Hung Huang, Sheng-Wei Cheng, Chung-Wei Yeh, Hung-I Chen, Ching-Pei Huang, Wei-Chun Fang, Ching-Chang Lin, Hui-Wen Lin, Sheng-Hsiang Hsieh, I-Chang Li, Yi-Heng |
author_facet | Chen, Po-Wei Feng, Wen-Han Ho, Ming-Yun Su, Chun-Hung Huang, Sheng-Wei Cheng, Chung-Wei Yeh, Hung-I Chen, Ching-Pei Huang, Wei-Chun Fang, Ching-Chang Lin, Hui-Wen Lin, Sheng-Hsiang Hsieh, I-Chang Li, Yi-Heng |
author_sort | Chen, Po-Wei |
collection | PubMed |
description | Background: P2Y12 inhibitor monotherapy is an alternative antiplatelet strategy in patients undergoing percutaneous coronary intervention (PCI). However, the ideal P2Y12 inhibitor for monotherapy is unclear. Methods and Results: We performed a multicenter, retrospective, observational study to compare the efficacy and safety of monotherapy with clopidogrel versus ticagrelor in patients with acute coronary syndrome (ACS) undergoing PCI. From 1 January 2014 to 31 December 2018, 610 patients with ACS who received P2Y12 monotherapy with either clopidogrel (n = 369) or ticagrelor (n = 241) after aspirin was discontinued prematurely were included. Inverse probability of treatment weighting was used to balance covariates between the groups. The primary endpoint was the composite of all-cause mortality, recurrent ACS or unplanned revascularization, and stroke within 12 months after discharge. Overall, 84 patients reached the primary endpoint, with 57 (15.5%) in the clopidogrel group and 27 (11.2%) in the ticagrelor group. Multivariate adjustment in Cox proportional-hazards models revealed a lower risk of the primary endpoint with ticagrelor than with clopidogrel (adjusted hazard ratio (aHR): 0.67, 95% confidence interval (CI): 0.49–0.93). Ticagrelor significantly reduced the risk of recurrent ACS or unplanned revascularization (aHR: 0.46, 95% CI: 0.28–0.75). No significant difference in all-cause mortality and major bleeding events was observed between the 2 groups. Conclusions: Among patients with ACS undergoing PCI who cannot complete course of dual antiplatelet therapy, a significantly lower risk of cardiovascular events was associated with ticagrelor monotherapy than with clopidogrel monotherapy. The major bleeding risk was similar in both the groups. |
format | Online Article Text |
id | pubmed-7355760 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-73557602020-07-23 P2Y12 Inhibitor Monotherapy with Clopidogrel versus Ticagrelor in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention Chen, Po-Wei Feng, Wen-Han Ho, Ming-Yun Su, Chun-Hung Huang, Sheng-Wei Cheng, Chung-Wei Yeh, Hung-I Chen, Ching-Pei Huang, Wei-Chun Fang, Ching-Chang Lin, Hui-Wen Lin, Sheng-Hsiang Hsieh, I-Chang Li, Yi-Heng J Clin Med Article Background: P2Y12 inhibitor monotherapy is an alternative antiplatelet strategy in patients undergoing percutaneous coronary intervention (PCI). However, the ideal P2Y12 inhibitor for monotherapy is unclear. Methods and Results: We performed a multicenter, retrospective, observational study to compare the efficacy and safety of monotherapy with clopidogrel versus ticagrelor in patients with acute coronary syndrome (ACS) undergoing PCI. From 1 January 2014 to 31 December 2018, 610 patients with ACS who received P2Y12 monotherapy with either clopidogrel (n = 369) or ticagrelor (n = 241) after aspirin was discontinued prematurely were included. Inverse probability of treatment weighting was used to balance covariates between the groups. The primary endpoint was the composite of all-cause mortality, recurrent ACS or unplanned revascularization, and stroke within 12 months after discharge. Overall, 84 patients reached the primary endpoint, with 57 (15.5%) in the clopidogrel group and 27 (11.2%) in the ticagrelor group. Multivariate adjustment in Cox proportional-hazards models revealed a lower risk of the primary endpoint with ticagrelor than with clopidogrel (adjusted hazard ratio (aHR): 0.67, 95% confidence interval (CI): 0.49–0.93). Ticagrelor significantly reduced the risk of recurrent ACS or unplanned revascularization (aHR: 0.46, 95% CI: 0.28–0.75). No significant difference in all-cause mortality and major bleeding events was observed between the 2 groups. Conclusions: Among patients with ACS undergoing PCI who cannot complete course of dual antiplatelet therapy, a significantly lower risk of cardiovascular events was associated with ticagrelor monotherapy than with clopidogrel monotherapy. The major bleeding risk was similar in both the groups. MDPI 2020-06-01 /pmc/articles/PMC7355760/ /pubmed/32492818 http://dx.doi.org/10.3390/jcm9061657 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Article Chen, Po-Wei Feng, Wen-Han Ho, Ming-Yun Su, Chun-Hung Huang, Sheng-Wei Cheng, Chung-Wei Yeh, Hung-I Chen, Ching-Pei Huang, Wei-Chun Fang, Ching-Chang Lin, Hui-Wen Lin, Sheng-Hsiang Hsieh, I-Chang Li, Yi-Heng P2Y12 Inhibitor Monotherapy with Clopidogrel versus Ticagrelor in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention |
title | P2Y12 Inhibitor Monotherapy with Clopidogrel versus Ticagrelor in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention |
title_full | P2Y12 Inhibitor Monotherapy with Clopidogrel versus Ticagrelor in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention |
title_fullStr | P2Y12 Inhibitor Monotherapy with Clopidogrel versus Ticagrelor in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention |
title_full_unstemmed | P2Y12 Inhibitor Monotherapy with Clopidogrel versus Ticagrelor in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention |
title_short | P2Y12 Inhibitor Monotherapy with Clopidogrel versus Ticagrelor in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention |
title_sort | p2y12 inhibitor monotherapy with clopidogrel versus ticagrelor in patients with acute coronary syndrome undergoing percutaneous coronary intervention |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7355760/ https://www.ncbi.nlm.nih.gov/pubmed/32492818 http://dx.doi.org/10.3390/jcm9061657 |
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