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- Title
Comparison of ticagrelor and clopidogrel in anemic patients with acute coronary syndrome: efficacy and safety outcomes over one year.
- Authors
Onuk, Tolga; Polat, Fuat; Yaylak, Barış; Akyüz, Şükrü; Kolak, Zeynep; Durak, Furkan
- Abstract
Objective: This retrospective study aimed to investigate the potential impact of ticagrelor and clopidogrel treatment on cardiovascular outcomes in patients with anemia and acute coronary syndrome (ACS) and to provide insights into the optimal therapeutic approach for this vulnerable patient population. Methods: A retrospective research design was employed, involving patients diagnosed with ST-segment elevation myocardial infarction (STEMI) or non-ST-segment elevation myocardial infarction (NSTEMI) between 2014 and 2021. Inclusion criteria required a hemoglobin level below 12 mg/dL and a minimum 12-month P2Y12 inhibitor treatment. Comprehensive clinical, biochemical, and echocardiographic data were collected from the hospital's electronic repository. The primary efficacy endpoint was major adverse cardiovascular events (MACE), encompassing total mortality, cardiovascular mortality, reinfarction, ischemic stroke, and hemorrhagic stroke. Major hemorrhage was the primary safety endpoint. Secondary outcomes included total mortality, cardiovascular mortality, reinfarction, ischemic stroke, and hemorrhagic stroke, individually. Results: Patients treated with ticagrelor (n = 118) and clopidogrel (n = 538) were compared. No significant difference was observed in major adverse cardiovascular events (MACE) and major bleeding between ticagrelor and clopidogrel treatment groups (MACE: clopidogrel 10.0% vs. ticagrelor 11.0%, p = 0.75; major bleeding: clopidogrel 2.8%, ticagrelor 2.5%, p = 0.88). Patients with hemoglobin levels ≤ 8 mg/dL demonstrated significantly higher MACE and major bleeding rates in the ticagrelor group (p = 0.008 and p = 0.002, respectively). Among patients aged ≥ 75 years, ticagrelor treatment was associated with a higher risk of major bleeding (p = 0.04). Conclusions: Ticagrelor and clopidogrel exhibited comparable efficacy and safety outcomes in anemic ACS patients over a one-year period. Although ticagrelor demonstrated superiority in reducing ischemic events, it is crucial to recognize the limitations of retrospective studies in informing clinical practice. This study offers valuable insights into tailoring antiplatelet therapy for anemic ACS patients and provides guidance for personalized treatment strategies, acknowledging the hypothesis-generating nature of retrospective analyses.
- Subjects
ANEMIA; MORTALITY; PATIENT safety; RECEIVER operating characteristic curves; STATISTICAL significance; ADENOSINE triphosphate; HEMOGLOBINS; MAJOR adverse cardiovascular events; TREATMENT effectiveness; RETROSPECTIVE studies; HEMORRHAGIC stroke; EVALUATION of medical care; MULTIVARIATE analysis; DESCRIPTIVE statistics; ACUTE coronary syndrome; CLOPIDOGREL; DRUG efficacy; ISCHEMIC stroke; CONFIDENCE intervals; DATA analysis software; ECHOCARDIOGRAPHY; PROPORTIONAL hazards models; REGRESSION analysis; EVALUATION
- Publication
European Journal of Clinical Pharmacology, 2024, Vol 80, Issue 5, p759
- ISSN
0031-6970
- Publication type
Article
- DOI
10.1007/s00228-024-03653-1