Comparison of ticagrelor with clopidogrel in patients with a planned invasive strategy for acute coronary syndromes (PLATO): a randomised double-blind study
Background - Variation in and irreversibility of platelet inhibition with clopidogrel has led to controversy about its optimum dose and timing of administration in patients with acute coronary syndromes. We compared ticagrelor, a more potent reversible P2Y12 inhibitor with clopidogrel in such patien...
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| Main Authors: | , , , , , , , , , , , , , , , |
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| Format: | Article (Journal) |
| Language: | English |
| Published: |
13 January 2010
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| In: |
The lancet
Year: 2010, Volume: 375, Issue: 9711, Pages: 283-293 |
| ISSN: | 1474-547X |
| DOI: | 10.1016/S0140-6736(09)62191-7 |
| Online Access: | Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1016/S0140-6736(09)62191-7 Verlag, lizenzpflichtig, Volltext: https://www.sciencedirect.com/science/article/pii/S0140673609621917 
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| Author Notes: | Christopher P Cannon, Robert A Harrington, Stefan James, Diego Ardissino, Richard C Becker, Håkan Emanuelsson, Steen Husted, Hugo Katus, Matyas Keltai, Nardev S Khurmi, Frederic Kontny, Basil S Lewis, Philippe Gabriel Steg, Robert F Storey, Daniel Wojdyla, Lars Wallentin for the PLATelet inhibition and patient Outcomes (PLATO) investigators |
| Summary: | Background - Variation in and irreversibility of platelet inhibition with clopidogrel has led to controversy about its optimum dose and timing of administration in patients with acute coronary syndromes. We compared ticagrelor, a more potent reversible P2Y12 inhibitor with clopidogrel in such patients. - Methods - At randomisation, an invasive strategy was planned for 13 408 (72·0%) of 18 624 patients hospitalised for acute coronary syndromes (with or without ST elevation). In a double-blind, double-dummy study, patients were randomly assigned in a one-to-one ratio to ticagrelor and placebo (180 mg loading dose followed by 90 mg twice a day), or to clopidogrel and placebo (300-600 mg loading dose or continuation with maintenance dose followed by 75 mg per day) for 6-12 months. All patients were given aspirin. The primary composite endpoint was cardiovascular death, myocardial infarction, or stroke. Analyses were by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT00391872. - Findings - 6732 patients were assigned to ticagrelor and 6676 to clopidogrel. The primary composite endpoint occurred in fewer patients in the ticagrelor group than in the clopidogrel group (569 [event rate at 360 days 9·0%] vs 668 [10·7%], hazard ratio 0·84, 95% CI 0·75-0·94; p=0·0025). There was no difference between clopidogrel and ticagrelor groups in the rates of total major bleeding (691 [11·6%] vs 689 [11·5%], 0·99 [0·89-1·10]; p=0·8803) or severe bleeding, as defined according to the Global Use of Strategies To Open occluded coronary arteries, (198 [3·2%] vs 185 [2·9%], 0·91 [0·74-1·12]; p=0·3785). - Interpretation - Ticagrelor seems to be a better option than clopidogrel for patients with acute coronary syndromes for whom an early invasive strategy is planned. - Funding - AstraZeneca. |
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| Item Description: | Gesehen am 29.03.2023 |
| Physical Description: | Online Resource |
| ISSN: | 1474-547X |
| DOI: | 10.1016/S0140-6736(09)62191-7 |