1. Effect of prior clopidogrel use on outcomes in medically managed acute coronary syndrome patients.
- Author
-
Chin CT, Boden WE, Roe MT, Neely B, Neely ML, Leiva-Pons JL, Corbalán R, Gottlieb S, Dalby AJ, Armstrong PW, Prabhakaran D, Fox KA, White HD, Ohman EM, Winters KJ, and Schiele F
- Subjects
- Acute Coronary Syndrome complications, Acute Coronary Syndrome diagnosis, Acute Coronary Syndrome mortality, Aged, Aspirin administration & dosage, Clopidogrel, Double-Blind Method, Drug Administration Schedule, Drug Therapy, Combination, Female, Hemorrhage chemically induced, Hospitalization, Humans, Kaplan-Meier Estimate, Male, Middle Aged, Myocardial Infarction etiology, Platelet Aggregation Inhibitors adverse effects, Prasugrel Hydrochloride administration & dosage, Proportional Hazards Models, Risk Assessment, Risk Factors, Stroke etiology, Ticlopidine administration & dosage, Ticlopidine adverse effects, Time Factors, Treatment Outcome, Acute Coronary Syndrome drug therapy, Platelet Aggregation Inhibitors administration & dosage, Ticlopidine analogs & derivatives
- Abstract
Objective: We investigated whether prior clopidogrel influenced long-term ischaemic and bleeding risks and modified the randomised treatment effect of clopidogrel versus prasugrel among medically managed patients with acute coronary syndromes (ACS) treated with dual antiplatelet therapy., Methods: Medically managed patients with ACS in the Targeted Platelet Inhibition to Clarify the Optimal Strategy to Medically Manage Acute Coronary Syndromes (TRILOGY ACS) trial were randomised to clopidogrel versus prasugrel (plus aspirin), stratified by prior clopidogrel use. From the analysis population (n=8927), we compared two groups: 'clopidogrel in-hospital (n=6513)' (clopidogrel started ≤72 h of presentation for index ACS event) and 'prior-clopidogrel (n=2414)' (on clopidogrel ≥5 days before index hospitalisation). Treatment-related differences in ischaemic (all-cause death, cardiovascular (CV) death, myocardial infarction (MI), stroke and the composite of CV death/MI/stroke) and bleeding outcomes (severe/life-threatening or moderate bleeding events based on Global Use of Strategies to Open Occluded Coronary Arteries (GUSTO) criteria) through 30 months were analysed between patients in the two groups., Results: Compared with 'clopidogrel in-hospital,' 'prior clopidogrel' patients were younger (median 64 years vs 66 years, p<0.001), more likely to have prior CV events/revascularisation, and had a higher frequency of CV death, MI or stroke through 30 months (20.8% vs 18.2%, p=0.002), with no difference in bleeding events (2.3% vs 3.4%, p=0.50). Randomised treatment effect (prasugrel vs clopidogrel) was similar for ischaemic and bleeding outcomes in both groups (all pinteraction>0.05)., Conclusions: Patients receiving clopidogrel before admission for ACS and subsequently treated only medically are at higher risk for CV events versus those not previously receiving clopidogrel. More potent antiplatelet inhibition with prasugrel versus clopidogrel did not significantly reduce this risk., Trial Registration Number: NCT00699998., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)
- Published
- 2016
- Full Text
- View/download PDF