Ticagrelor versus Clopidogrel in Symptomatic Peripheral Artery Disease
| Autor: | Valentyn Maslovskyi, Tulio Navarro, Vikram Kashyap, Ian Chetter, Peter Gillgren, Patrice Cacoub, Jeffrey Berger, Pascual Lozano-Vilardell, Gerard Stansby, ANTONIO GIMENEZ-GAIBAR, Jill JF Belch, Isabelle Quere, Maciej Geremek, Damien Lanéelle, Katalin Farkas, Juraj Madaric |
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| Přispěvatelé: | Hiatt, William R., Fowkes, F. Gerry R., Heizer, Gretchen, Berger, Jeffrey S., Baumgartner, Iri, Held, Peter, Katona, Brian G., Mahaffey, Kenneth W., Norgren, Lar, Jones, W. Schuyler, Blomster, Juuso, Millegård, Marcu, Reist, Craig, Patel, Manesh R. |
| Jazyk: | angličtina |
| Rok vydání: | 2017 |
| Předmět: |
Male
Ticagrelor Adenosine medicine.medical_treatment Kaplan-Meier Estimate 030204 cardiovascular system & hematology 0302 clinical medicine Ischemia Cardiovascular Disease 030212 general & internal medicine Myocardial infarction 610 Medicine & health Aspirin Medicine (all) General Medicine Middle Aged Clopidogrel Cardiovascular Diseases Anesthesia Cardiology Platelet aggregation inhibitor Female medicine.symptom Human medicine.drug medicine.medical_specialty Ticlopidine Hemorrhage Revascularization Peripheral Arterial Disease 03 medical and health sciences Double-Blind Method Internal medicine medicine Humans cardiovascular diseases Aged Leg business.industry Platelet Aggregation Inhibitor Intermittent Claudication Purinergic P2Y Receptor Antagonist medicine.disease Intermittent claudication Purinergic P2Y Receptor Antagonists business Platelet Aggregation Inhibitors |
| Zdroj: | Hiatt, William R; Fowkes, F Gerry R; Heizer, Gretchen; Berger, Jeffrey S; Baumgartner, Iris; Held, Peter; Katona, Brian G; Mahaffey, Kenneth W; Norgren, Lars; Jones, W Schuyler; Blomster, Juuso; Millegård, Marcus; Reist, Craig; Patel, Manesh R (2017). Ticagrelor versus Clopidogrel in Symptomatic Peripheral Artery Disease. New England journal of medicine NEJM, 376(1), pp. 32-40. Massachusetts Medical Society MMS 10.1056/NEJMoa1611688 |
| DOI: | 10.1056/NEJMoa1611688 |
| Popis: | Background Peripheral artery disease is considered to be a manifestation of systemic atherosclerosis with associated adverse cardiovascular and limb events. Data from previous trials have suggested that patients receiving clopidogrel monotherapy had a lower risk of cardiovascular events than those receiving aspirin. We wanted to compare clopidogrel with ticagrelor, a potent antiplatelet agent, in patients with peripheral artery disease. Methods In this double-blind, event-driven trial, we randomly assigned 13,885 patients with symptomatic peripheral artery disease to receive monotherapy with ticagrelor (90 mg twice daily) or clopidogrel (75 mg once daily). Patients were eligible if they had an ankle-brachial index (ABI) of 0.80 or less or had undergone previous revascularization of the lower limbs. The primary efficacy end point was a composite of adjudicated cardiovascular death, myocardial infarction, or ischemic stroke. The primary safety end point was major bleeding. The median follow-up was 30 months. Results The median age of the patients was 66 years, and 72% were men; 43% were enrolled on the basis of the ABI and 57% on the basis of previous revascularization. The mean baseline ABI in all patients was 0.71, 76.6% of the patients had claudication, and 4.6% had critical limb ischemia. The primary efficacy end point occurred in 751 of 6930 patients (10.8%) receiving ticagrelor and in 740 of 6955 (10.6%) receiving clopidogrel (hazard ratio, 1.02; 95% confidence interval [CI], 0.92 to 1.13; P=0.65). In each group, acute limb ischemia occurred in 1.7% of the patients (hazard ratio, 1.03; 95% CI, 0.79 to 1.33; P=0.85) and major bleeding in 1.6% (hazard ratio, 1.10; 95% CI, 0.84 to 1.43; P=0.49). Conclusions In patients with symptomatic peripheral artery disease, ticagrelor was not shown to be superior to clopidogrel for the reduction of cardiovascular events. Major bleeding occurred at similar rates among the patients in the two trial groups. (Funded by AstraZeneca; EUCLID ClinicalTrials.gov number, NCT01732822 .). |
| Databáze: | OpenAIRE |
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