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Ticagrelor vs clopidogrel after fibrinolytic therapy in patients with ST-elevation myocardial infarction a randomized clinical trial
- Source :
- Repositório Institucional da USP (Biblioteca Digital da Produção Intelectual), Universidade de São Paulo (USP), instacron:USP, JAMA Cardiol
- Publication Year :
- 2018
-
Abstract
- 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
- Subjects :
- Male
Ischemic Heart Disease Anticoagulation
medicine.medical_specialty
Acute coronary syndrome
Ticagrelor
medicine.medical_treatment
Myocardial Infarction
Cardiology
Bleeding and Transfusion
Hemorrhage
030204 cardiovascular system & hematology
Loading dose
Clinical Pharmacy and Pharmacology
law.invention
03 medical and health sciences
0302 clinical medicine
Percutaneous Coronary Intervention
Fibrinolytic Agents
Randomized controlled trial
law
Internal medicine
Medicine
Humans
purl.org/pe-repo/ocde/ford#3.02.04 [https]
Thrombolytic Therapy
030212 general & internal medicine
Myocardial infarction
cardiovascular diseases
Aged
Original Investigation
business.industry
Correction
Thrombolysis
Middle Aged
medicine.disease
Clopidogrel
INFARTO DO MIOCÁRDIO
Emergency Medicine
ST Elevation Myocardial Infarction
Female
Cardiology and Cardiovascular Medicine
business
Acute Coronary Syndromes
TIMI
medicine.drug
Subjects
Details
- Database :
- OpenAIRE
- Journal :
- Repositório Institucional da USP (Biblioteca Digital da Produção Intelectual), Universidade de São Paulo (USP), instacron:USP, JAMA Cardiol
- Accession number :
- edsair.doi.dedup.....397c5b1c6ba83e65be290831f337ce99