Ticagrelor: Long-Term Therapy in Patients with Coronary Artery Disease
Andrea Rognoni1, Chiara Cavallino, Alessandro Lupi
1Coronary Care Unit and Catheterization Laboratory, "Maggiore della Carità" Hospital, Corso Mazzini 18, 28100 Novara, Italy.
Insights
Long-term ticagrelor therapy shows clinical benefit for secondary prevention of ischemic events after acute coronary syndrome. However, its use requires careful consideration of individual patient bleeding and ischemic risk.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Medicine
Background:
- Atherothrombosis and coronary artery disease are leading causes of death globally, impacting millions.
- Chronic stable angina significantly impairs quality of life and increases healthcare costs.
- Activated platelets play a crucial role in the pathophysiology of cardiovascular events.
Purpose of the Study:
- To review the long-term effects of ticagrelor therapy based on recent evidence.
- To evaluate the role of P2Y12 receptor antagonists in secondary cardiovascular prevention.
Main Methods:
- Conducted an online search of major search engines.
- Included six randomized controlled trials and ten post-hoc analyses, sub-studies, and registries.
- Summarized randomized controlled trials, noting therapy type and clinical follow-up duration.
Main Results:
- The PEGASUS-TIMI 54 study demonstrated a clinical benefit of 3-year ticagrelor (60 mg twice daily) therapy for secondary ischemic event prevention post-acute coronary syndrome.
- Dual anti-platelet therapy with ticagrelor and aspirin showed merit in specific patient populations.
- Effectiveness is not generalizable to patients with high bleeding risk or low ischemic risk.
Conclusions:
- Prolonged ticagrelor 60 mg with aspirin may benefit patients with recurrent ischemic events or multiple coronary revascularizations, especially those with lower bleeding risk.
- Careful patient selection is crucial, considering both ischemic and bleeding risks.
- The role of P2Y12 antagonists in long-term secondary prevention is an evolving area.
Introduction:
Atherothrombosis and coronary artery disease affect more than 13 million individuals only in the United States, about 8 millions in Europe and are the major causes of death worldwide. In particular chronic stable angina impairs patient quality of life, is associated with an important health spending and increased patient mortality; it is a prominent symptom of coronary artery disease (CAD), the latter being prevalent worldwide in patients. A key role in pathophysiology of cardiovascular acute events is played by activated platelets. Aspirin and adenosine diphosphate antagonist in addition to it is recommended for 1 year for reduction of cardiovascular events in patients with prior myocardial infarction with a weak recommendation to continue thereafter. P2Y12 receptor antagonists, in addition to aspirin, have been shown in the last years, to reduce ischemic events in patients with acute coronary syndrome but their role in secondary prevention is still new and unclear. The aim of our paper is to review the long-term effect of therapy with ticagrelor on the basis of recent evidence based data.
Methods:
We performed an online search on the major search engines. All the randomized controlled trials were summarized in the table.
Results:
We included in our paper six randomized controlled trials and we mentioned about ten post - hoc analysis, sub studies and registries. All studies included the type the therapy and a mid or long term clinical follow up.
Conclusions:
The studies reported in our paper and in particular PEGASUS - TIMI 54 study showed the merit to placing attention of prevention secondary ischemic events after acute coronary syndrome in the context of treatment with dual anti - platelet therapy; it proved a clinical benefit in patients treated with ticagrelor (60 mg x 2) for 3 years. Nevertheless, the effectiveness of these results cannot be generalized to patients with higher bleeding risk or low ischemic risk. In fact prolonged therapy with ticagrelor 60 mg in combination with aspirin could be considered valuable in patients with repeated acute ischemic events or with several coronary revascularizations over time (especially in patients with lower bleeding risk).
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