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. 2018 Oct 11;2(4):e357-e368.
doi: 10.1055/s-0038-1673389. eCollection 2018 Oct.

Safety of Ticagrelor Compared to Clopidogrel after Prehospital Initiation of Treatment

Thomas O Bergmeijer  1 , Mathijs van Oevelen  1 , Paul W A Janssen  1 , Thea C Godschalk  1 , Robert A Lichtveld  2 , Johannes C Kelder  1 , Michiel Voskuil  3 , Arend Mosterd  4 , Gilles Montalescot  5 , Jurriën M Ten Berg  1
Affiliations

Safety of Ticagrelor Compared to Clopidogrel after Prehospital Initiation of Treatment

Thomas O Bergmeijer et al. TH Open. .

Abstract

Objectives The objective of this registry was to study the safety of prehospital initiation of ticagrelor compared with clopidogrel. Background Ticagrelor has replaced clopidogrel in many hospitals as the routinely used antiplatelet drug in patients with ST-segment elevation myocardial infarction (STEMI). Nevertheless, in the PLATelet inhibition and patient Outcomes (PLATO) trial, ticagrelor was associated with an increase in non-CABG (non-coronary artery bypass grafting)-related major bleeding. Data comparing the safety of ticagrelor and clopidogrel after prehospital initiation of treatment are not available. Methods A retrospective, multicenter registry was performed. Selection criteria were the administration of a prehospital loading dose of ticagrelor or clopidogrel according to the ambulance STEMI treatment protocol and the presentation to a percutaneous coronary intervention-capable hospital in our region between January 2011 and December 2012. Follow-up was performed using the electronic patient files for the time period between the antiplatelet loading dose and hospital discharge. The data were analyzed using a primary bleeding end point (any bleeding) and a secondary thrombotic end point (all-cause mortality, spontaneous myocardial infarction, definite stent thrombosis, stroke, or transient ischemic attack). Results Data of 304 clopidogrel-treated and 309 ticagrelor-treated patients were available for analysis. No significant difference in bleeding rate was observed between both groups, using univariate (17.8 vs. 20.1%; p = 0.47; odds ratio, 1.16 [95% confidence interval, 0.78-1.74]) and multivariate ( p = 0.42) analysis. Also for the secondary thrombotic end point (6.3 vs. 4.9%, p = 0.45), no significant differences were observed. Conclusion In this real-world registry, no significant differences in bleeding or thrombotic event rate were found between ticagrelor and clopidogrel after prehospital initiation of treatment.

Keywords: clopidogrel; hemorrhage; myocardial infarction; prehospital emergency care; ticagrelor.

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Conflict of interest statement

Conflicts of Interest Dr. J.M. ten Berg reports receiving fees for board membership from AstraZeneca, consulting fees from AstraZeneca, Eli Lilly, and Merck, and lecture fees from Daiichi Sankyo and Eli Lilly, AstraZeneca, Sanofi, and Accumetrics.

Dr. G. Montalescot reports research Grants to the Institution or Consulting/Lecture Fees from Acuitude, ADIR, Amgen, AstraZeneca, Bayer, Berlin Chimie AG, Boehringer Ingelheim, Bristol-Myers Squibb, Brigham Women's Hospital, Cardiovascular Research Foundation, Celladon, CME resources, Daiichi-Sankyo, Eli-Lilly, Europa, Fédération Française de Cardiologie, Gilead, Hopitaux Universitaires Genève, ICAN, Janssen-Cilag, Lead-Up, Medcon International, Menarini, Medtronic, MSD, Pfizer, Recor, Sanofi-Aventis, Stentys, The Medicines Company, TIMI Study Group, Universitat Basel, WebMD, and Zoll Medical.

All other authors have nothing to disclose.

Figures

Fig. 1
Fig. 1
Distribution of BARC bleeding scores. Distribution of BARC bleeding scores for all BARC subgroups ( A ) and for combined BARC 2–5 bleeding ( B ). BARC, Bleeding Academic Research Consortium.
Fig. 2
Fig. 2
Subgroup analysis for interaction. p -Value is the value for interaction. ASA, acetylsalicylic acid; BMI, body mass index; CI, confidence interval; CVD, cardiovascular disease; DES, drug-eluting stent; eGFR, estimated glomerular filtration rate; GPI, glycoprotein GPIIb/IIIa inhibitor; n , number; OR, odds ratio; PCI, percutaneous coronary intervention; STEMI, ST-segment elevation myocardial infarction; TIA, transient ischemic attack; TIMI, thrombolysis in myocardial infarction.
See this image and copyright information in PMC

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