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Ticagrelor vs clopidogrel when coadministered with bivalirudin in patients with acute coronary syndrome undergoing

Yang Li1, Yi Li1, Miaohan Qiu1

  • 1Cardiovascular Research Institute and Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China.

Research and Practice in Thrombosis and Haemostasis
|April 16, 2024
PubMed

Insights

Bivalirudin plus ticagrelor significantly reduced ischemic events and stroke in acute coronary syndrome patients undergoing percutaneous coronary intervention compared to bivalirudin plus clopidogrel, without increasing bleeding risk.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Pharmacology

Background:

  • Optimal perioperative antithrombotic strategy for acute coronary syndrome (ACS) during percutaneous coronary intervention (PCI) is debated.
  • Real-world data on bivalirudin combined with ticagrelor versus clopidogrel in ACS patients undergoing PCI is limited.

Purpose of the Study:

  • To evaluate the safety and effectiveness of bivalirudin plus ticagrelor compared to bivalirudin plus clopidogrel.
  • To assess the incidence of ischemic events and bleeding in ACS patients undergoing PCI.

Main Methods:

  • Retrospective cohort study of 7234 ACS patients undergoing PCI between March 2016 and March 2019.
  • Patients received bivalirudin periprocedurally with either ticagrelor or clopidogrel.
  • Comparison of 12-month incidence rates for ischemia, all-cause death, and Bleeding Academic Research Consortium (BARC) types 2, 3, and 5 bleeding.

Main Results:

  • Bivalirudin plus ticagrelor (n=2274) was associated with significantly lower ischemic events (1.74% vs 2.84%) and stroke (0.05% vs 1.01%) compared to bivalirudin plus clopidogrel (n=4960).
  • No significant increase in BARC type 2,3,5 bleeding (4.49% vs 3.76%) or BARC type 3,5 bleeding (2.84% vs 2.02%) was observed with ticagrelor.
  • These benefits were consistent across subgroups.

Conclusions:

  • Bivalirudin plus ticagrelor is a safe and effective initial treatment strategy for ACS patients undergoing PCI.
  • This combination reduces the risk of ischemic events without a significant increase in bleeding complications.
  • Findings support the use of bivalirudin plus ticagrelor in real-world ACS PCI settings.
Abstract

Keywords:
acute coronary syndromeantithrombotic therapybivalirudinclopidogrelpercutaneous coronary interventionticagrelor

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