Modern antithrombotic treatment after ACS – do we use it adequately?

Česká verzia

Authors: J. Špinar ¹; J. Vítovec ²
Authors place of work: Interní kardiologická klinika LF MU a FN Brno, Brno ¹; I. interní kardioangiologická klinika LF MU a FN u sv. Anny v Brně ²
Published in the journal: Kardiol Rev Int Med 2017, 19(1): 56-60

Summary

Ticagrelor is an adenosine derivate and it is an oral, reversible, direct inhibitor of adenosine diphosphate (ADP) receptor type P2Y₁₂ with a rapid effect and higher anti-aggregation activity than clopidogrel. Ticagrelor (180mg loading dose, 90mg twice daily long term) was tested against clopidogrel (300–600mg loading dose, 75mg long term) in the PLATO study in 18,624 patients after acute coronary syndrome with or without ST elevation. The combined endpoint defined as death, myocardial infarction or stroke was observed in 9.8% of subjects in the Ticagrelor group and in 11.7% in the clopidogrel group after 12 months (p < 0.001). There was no difference in bleeding (11.6 vs. 11.2%, p = 0.43). Ticagrelor decreased significantly the primary endpoint from 22.0 to 17.3% in patients with chronic kidney disease (creatinine clearance less than 60 ml/min, n = 3.237) with more significant decrease of the absolute risk when compared to the whole population (7.9 vs. 8.9%). The PEGASUS-TIMI 54 tested the long-term effect of Ticagrelor after myocardial infarction and showed a decrease of the risk of death after myocardial infarction and stroke with a small increase in bleeding.

Keywords:
ticagrelor – myocardial infarction – anti-aggregation – renal functions

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