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Microfluidics in Assessing Platelet Function
Published on: November 8, 2024
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Comparative Effectiveness and Safety of Ticagrelor and Clopidogrel in Patients With or Without Chronic Liver Disease:
Bin Hong1, Sungho Bea2, Seng Chan You3
1School of Pharmacy, Sungkyunkwan University, Suwon, South Korea.
The American Journal of Medicine
|April 19, 2024
Summary
Ticagrelor and clopidogrel show similar risks for major adverse cardiovascular events (MACE) in patients with and without chronic liver disease. However, ticagrelor is associated with increased major bleeding risk, irrespective of liver disease status.
Area of Science:
- Cardiology
- Pharmacology
- Hepatology
Background:
- Limited evidence exists comparing ticagrelor and clopidogrel in patients with chronic liver disease.
- Effectiveness and safety profiles of these antiplatelet agents may differ in patients with chronic liver disease.
Purpose of the Study:
- To evaluate the risk of major adverse cardiovascular events (MACE) and major bleeding.
- To compare ticagrelor versus clopidogrel in patients undergoing percutaneous coronary intervention (PCI) for acute coronary syndrome.
- To assess if these risks vary based on chronic liver disease status.
Main Methods:
- Utilized the Korean healthcare claim database for adult patients diagnosed with acute coronary syndrome and undergoing PCI.
- Patients initiated on ticagrelor or clopidogrel within 7 days of diagnosis were classified into chronic liver disease and non-chronic liver disease groups.
- Propensity score (PS) matching (1:1) and Cox proportional hazards models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for MACE and major bleeding.
Main Results:
- The study included 14,261 patients with chronic liver disease and 148,535 without, post-PS matching.
- No significant difference in MACE risk was observed between ticagrelor and clopidogrel, regardless of chronic liver disease status (HR: 1.01-1.02).
- Ticagrelor was associated with an increased risk of major bleeding compared to clopidogrel (HR: 1.32 in non-liver disease group), but this risk did not significantly vary between patients with and without chronic liver disease (P for homogeneity: 0.342).
Conclusions:
- Ticagrelor and clopidogrel demonstrate similar risks for MACE in acute coronary syndrome patients undergoing PCI.
- Ticagrelor use is linked to an increased risk of major bleeding compared to clopidogrel.
- The risks of MACE and major bleeding associated with ticagrelor versus clopidogrel do not appear to be influenced by the presence of chronic liver disease.
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