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Ticagrelor and Infection Risk in Patients with Coronary Artery Disease
Lourdes Vicent1,2, Vanesa Bruña3,4, Carolina Devesa4,5,6
1Servicio de Cardiología, Hospital General Universitario 12 de Octubre, Madrid, Spain, mlourdesvicent@gmail.com.
Insights
Ticagrelor, a P2Y12 inhibitor, was associated with a lower infection risk in coronary artery disease patients compared to prasugrel and clopidogrel. This finding suggests a potential benefit of ticagrelor in managing infections in this population.
Area of Science:
- Cardiology
- Infectious Diseases
- Pharmacology
Background:
- Ticagrelor exhibits in vitro bactericidal properties.
- Clinical observations suggest ticagrelor may be beneficial in treating infections.
Purpose of the Study:
- To investigate and compare the incidence of infections in patients treated with three different P2Y12 receptor inhibitors: ticagrelor, prasugrel, and clopidogrel.
Main Methods:
- A retrospective registry study was conducted in a cardiology department.
- Patients with coronary artery disease (CAD) discharged on ticagrelor, prasugrel, or clopidogrel between March 2017 and June 2019 were analyzed.
- Infection risk was assessed during the P2Y12 inhibitor treatment period (mean 12.4 months).
Main Results:
- Of 250 patients, 87 (34.8%) experienced infections. Ticagrelor (25.3%) was associated with fewer infections than prasugrel (33.7%) and clopidogrel (48.6%) (p=0.009).
- Ticagrelor use was independently linked to a reduced likelihood of infection (HR 0.52; 95% CI 0.28-0.95; p=0.035) compared to clopidogrel.
- ST-segment elevation myocardial infarction (STEMI) was the primary indication for drug use, with prasugrel predominantly used in STEMI cases.
Conclusions:
- Ticagrelor-treated patients with coronary artery disease showed a lower incidence of infections compared to those on other P2Y12 inhibitors.
- Further research is warranted to elucidate the specific bactericidal mechanisms of ticagrelor in this clinical context.
Background:
Ticagrelor has a bactericidal effect in vitro, and clinical studies suggest a beneficial effect in infections. Our aim was to determine the incidence of infections in patients treated with 3 different P2Y12 receptor inhibitors.
Methods:
Retrospective registry in a cardiology department. Patients with coronary artery disease discharged on ticagrelor, prasugrel, or clopidogrel from March 2017 to June 2019 were included. The risk of infection was analyzed during the period of P2Y12 inhibitor treatment (12.4 ± 6.7 months).
Results:
A total of 250 patients were included (ticagrelor 91 [36.4%], prasugrel 89 [35.6%], clopidogrel 70 [28.0%]). Mean age was 61.0 ± 13.1 years, and 63 (25.2%) were women. The most common reason to use these drugs was ST-segment elevation acute myocardial infarction (STEMI) (152 patients - 60.8%). STEMI was the reason to use prasugrel in 84 patients (94.4%), ticagrelor in 44 (48.4%), and clopidogrel in 24 (34.3%), p < 0.001. An infection during follow-up was seen in 87 patients (34.8%), 23 treated with ticagrelor (25.3%), 30 with prasugrel (33.7%) and 34 with clopidogrel (48.6%), p = 0.009. Ticagrelor was independently associated with a lower likelihood of infection (Hazard Ratio [HR] 0.52, 95% confidence interval [CI] 0.28-0.95; p = 0.035) compared to prasugrel (HR 0.96, 95% CI 0.54-1.73; p = 0.909) and clopidogrel (HR = 1).
Conclusions:
In patients admitted with coronary artery disease patients treated with ticagrelor had a lower frequency of infections during follow-up than those treated with other P2Y12 inhibitors. Further studies are necessary to clarify the bactericidal effect of ticagrelor in this context.
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