Related Experiment Video
Updated: Jul 6, 2025
Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
Published on: March 15, 2022
Ticagrelor or prasugrel vs. clopidogrel in patients with atrial fibrillation undergoing percutaneous coronary
Sissel J Godtfredsen1, Kristian H Kragholm1, Anna Meta Dyrvig Kristensen2
1Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.
Insights
Ticagrelor or prasugrel reduced major adverse cardiovascular events in atrial fibrillation patients undergoing myocardial infarction treatment. This P2Y12 inhibitor use did not increase bleeding risk compared to clopidogrel.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Research
Background:
- Patients with atrial fibrillation (AF) on oral anticoagulation (OAC) undergoing percutaneous coronary intervention (PCI) for myocardial infarction (MI) require effective antiplatelet therapy.
- The comparative efficacy and safety of newer P2Y12 inhibitors (ticagrelor or prasugrel) versus clopidogrel in this high-risk population remain incompletely understood.
Purpose of the Study:
- To evaluate the efficacy and safety of ticagrelor or prasugrel compared to clopidogrel in patients with AF on OAC undergoing PCI for MI.
Main Methods:
- Nationwide cohort study of 2259 patients with AF on OAC who underwent PCI for MI (2011-2019).
- Patients received either clopidogrel (84.9%) or ticagrelor/prasugrel (15.1%) at discharge.
- Primary efficacy outcome: major adverse cardiovascular events (MACE). Primary safety outcome: major bleeding requiring hospitalization. Standardized risks were calculated using multivariable logistic regression.
Main Results:
- The standardized risk of MACE at 1 year was significantly lower with ticagrelor or prasugrel (16.3%) compared to clopidogrel (19.4%) (RR 0.84; P=0.02).
- There was no significant difference in the risk of bleeding between the groups (ticagrelor/prasugrel 5.5% vs. clopidogrel 5.1%) (RR 1.07; P=0.69).
- Outcomes were standardized for CHA2DS2-VASc, HAS-BLED scores, OAC type, aspirin, and proton pump inhibitor use.
Conclusions:
- In patients with AF on OAC undergoing PCI for MI, ticagrelor or prasugrel is associated with reduced ischemic risk compared to clopidogrel.
- This benefit was observed without a corresponding increase in the risk of major bleeding.
Aims:
The efficacy and safety of ticagrelor or prasugrel vs. clopidogrel in patients with atrial fibrillation (AF) on oral anticoagulation (OAC) undergoing percutaneous coronary intervention (PCI) for myocardial infarction (MI) have not been established.
Methods And Results:
This was a nationwide cohort study of patients on OAC for AF who underwent PCI for MI from 2011 through 2019 and were prescribed a P2Y12 inhibitor at discharge. The primary efficacy outcome was major adverse cardiovascular events (MACE), defined as a composite of death from any cause, stroke, recurrent MI, or repeat revascularization. The primary safety outcome was cerebral, gastrointestinal, or urogenital bleeding requiring hospitalization. Absolute and relative risks for outcomes at 1 year were calculated through multivariable logistic regression with average treatment effect modelling. Outcomes were standardized for the individual components of the CHA2DS2-VASc and HAS-BLED scores as well as type of OAC, aspirin, and proton pump inhibitor use. We included 2259 patients of whom 1918 (84.9%) were prescribed clopidogrel and 341 (15.1%) ticagrelor or prasugrel. The standardized risk of MACE was significantly lower in the ticagrelor or prasugrel group compared with the clopidogrel group (standardized absolute risk, 16.3% vs. 19.4%; relative risk, 0.84, 95% confidence interval, 0.70-0.98; P = 0.02), while the risk of bleeding did not differ (standardized absolute risk, 5.5% vs. 5.1%; relative risk, 1.07, 95% confidence interval, 0.73-1.41; P = 0.69).
Conclusion:
In patients with AF on OAC who underwent PCI for MI, treatment with ticagrelor or prasugrel vs. clopidogrel was associated with reduced ischaemic risk, without a concomitantly increased bleeding risk.
Related Concept Videos
01:20Antiplatelet Drugs: Prostaglandin Synthesis, P2Y12 and Glycoprotein IIb/IIIa Inhibitors
Prostaglandin synthesis inhibitors, exemplified by the widely known aspirin, wield their power by irreversibly acetylating...
01:18Anticoagulant Drugs: Vitamin K Antagonists and Direct Oral Anticoagulants
Warfarin, a prominent vitamin K antagonist family member, exerts its effect by inhibiting the enzyme VKORC1 (vitamin K epoxide reductase complex 1). By hindering this enzyme, warfarin...
01:23Treatment for Pulmonary Arterial Hypertension: Prostacyclin Receptor Agonists
These agonists bind to the IPR receptor situated on the plasma membrane of the pulmonary artery smooth muscle cells. This binding triggers a cascade of reactions known as the GS-AC-cAMP-PKA pathway. This pathway results in the relaxation of smooth muscle...