16 research outputs found
Ticagrelor versus clopidogrel in patients with acute coronary syndromes and chronic obstructive pulmonary disease: An analysis from the platelet inhibition and patient outcomes (PLATO) trial
Background
Patients with chronic obstructive pulmonary disease (COPD) experiencing acute coronary syndromes (ACS) are at high risk for clinical events. In the Platelet Inhibition and Patient Outcomes (PLATO) trial, ticagrelor versus clopidogrel reduced the primary endpoint of death from vascular causes, myocardial infarction, or stroke after ACS, but increased the incidence of dyspnea, which may lead clinicians to withhold ticagrelor from COPD patients.
Methods and Results
In 18 624 patients with ACS randomized to treatment with ticagrelor or clopidogrel, history of COPD was recorded in 1085 (5.8%). At 1 year, the primary endpoint occurred in 17.7% of patients with COPD versus 10.4% in those without COPD (P<0.001). The 1âyear event rate for the primary endpoint in COPD patients treated with ticagrelor versus clopidogrel was 14.8% versus 20.6% (hazard ratio [HR]=0.72; 95% confidence interval [CI]: 0.54 to 0.97), for death from any cause 8.4% versus 12.4% (HR=0.70; 95% CI: 0.47 to 1.04), and for PLATOâdefined major bleeding rates at 1 year 14.6% versus 16.6% (HR=0.85; 95% CI: 0.61 to 1.17). Dyspnea occurred more frequently with ticagrelor (26.1% vs. 16.3%; HR=1.71; 95% CI: 1.28 to 2.30). There was no differential increase in the relative risk of dyspnea compared to nonâCOPD patients (HR=1.85). No COPD statusâbyâtreatment interactions were found, showing consistency with the main trial results.
Conclusions
In this postâhoc analysis, COPD patients experienced high rates of ischemic events. Ticagrelor versus clopidogrel reduced and substantially decreased the absolute risk of ischemic events (5.8%) in COPD patients, without increasing overall major bleeding events. The benefitârisk profile supports the use of ticagrelor in patients with ACS and concomitant COPD.
Clinical Trial Registration
URL: http://www.clinicaltrials.gov. Unique identifier: NCT00391872
Article Commentary: The Alternatively Spliced Form âbâ of the Epithelial Sodium Channel α subunit (α ENaC): Any Prior Evidence of its Existence?
A Novel Mechanism in Regulating the Alpha-Subunit of the Epithelial Sodium Channel (α ENaC) by the Alternatively Spliced Form α ENaC-b
Fitotoxicidade do herbicida CP. 50 144 para Sesamun indicum L. e Phaseolus vulgaris L. cultivados em soluçÔes nutritivas
Coupling between H+ transport and anaerobic glycolysis in turtle urinary bladder: Effects of inhibitors of H+ ATPase
Antithrombotic therapy in the elderly: expert position paper of the European Society of Cardiology Working Group on Thrombosis
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Expert position paper on the use of proton pump inhibitors in patients with cardiovascular disease and antithrombotic therapy
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