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Propensity-matched analysis of the protective effect of ticagrelor versus clopidogrel on the risk of developing
Chris A Gentry1, Charles M Whitman1, Brian S Kliewer2
1Pharmacy Service, Oklahoma City Veterans Affairs Health Care System, Oklahoma City, Oklahoma, USA.
Insights
Ticagrelor use in acute coronary syndrome patients was associated with a lower risk of Staphylococcus aureus bacteremia (SAB) compared to clopidogrel. These findings suggest ticagrelor may help prevent SAB in this population.
Area of Science:
- Cardiology
- Infectious Diseases
- Pharmacology
Background:
- Ticagrelor, a P2Y12 inhibitor used for acute coronary syndromes (ACS), exhibits antibacterial properties.
- Emerging data suggest potential benefits in infection management.
- Staphylococcus aureus bacteremia (SAB) is a significant concern in ACS patients.
Purpose of the Study:
- To evaluate the protective effect of ticagrelor against SAB in ACS patients.
- To compare SAB risk between ticagrelor and clopidogrel users via propensity-matched analysis.
Main Methods:
- Retrospective, nationwide analysis of Veterans Affairs Medical Center patients with ACS.
- Inclusion criteria: prescription of clopidogrel or ticagrelor.
- Primary outcome: comparative rate of SAB between propensity-matched ticagrelor and clopidogrel cohorts.
Main Results:
- Analysis included 24,456 ticagrelor users and 277,277 clopidogrel users.
- Propensity-matched analysis revealed significantly lower SAB rates in the ticagrelor group (0.13% vs. 0.29%, OR 0.43, P<0.0001).
- Independent predictors of SAB included clopidogrel use, dermatologic/hematologic conditions, and anemia.
Conclusions:
- Ticagrelor use was associated with a reduced risk of developing Staphylococcus aureus bacteremia in ACS patients.
- Findings support a potential role for ticagrelor in SAB prevention.
- Further research may elucidate the mechanisms behind ticagrelor's protective effects.
Objective:
Recent data indicate that ticagrelor, used in acute coronary syndromes (ACS), has antibacterial effects against Staphylococcus sp. and other effects that may help management of infection. The primary objective of this study was to evaluate the protective effect of ticagrelor in patients who have had an ACS event and the risk of developing Staphylococcus aureus bacteremia (SAB) compared to a propensity-matched cohort receiving clopidogrel.
Methods:
This study was a retrospective, nationwide analysis of all patients presenting to any percutaneous coronary intervention-performing Veterans Affairs Medical Center with an ACS episode and resultant prescription for clopidogrel or ticagrelor. The primary outcome was the comparative rate of SAB in patients receiving ticagrelor vs. clopidogrel.
Results:
Analysis involved 24 456 patients on ticagrelor and 277 277 patients on clopidogrel. There was a statistically significant difference in the number of patients developing SAB between the propensity-matched groups (32 [0.13%] of 24 456 for ticagrelor vs. 71 [0.29%] of 24 456 for clopidogrel; odds ratio (OR), 0.43; 95% confidence interval (CI), 0.28-0.65; P<0.0001). Multivariate logistic regression showed that receipt of clopidogrel, comorbid dermatologic condition, comorbid hematologic condition, and baseline anemia were independently associated with the development of SAB.
Conclusions:
The study findings align with recent reports that ticagrelor may have a beneficial role in the prevention of SAB.
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