Ticagrelor is a reversible, direct-acting, oral P2Y12-receptor antagonist that provides greater and more consistent platelet inhibition than clopidogrel.  In the PLATO (PLATelet inhibition and patient Outcomes) trial, ticagrelor was found to be superior to clopidogrel for the treatment of a broad spectrum of patients admitted to hospital with an acute coronary syndrome.  In this paper, data from the PLATO-Invasive substudy is presented.

At randomisation an invasive strategy was planned for 13408 of the 18624 patients in the trial hospitalised for acute coronary syndromes (72%).  Patients were randomly assigned in a one-to-one ratio to either ticragelor and placebo, or to clopidogrel and placebo for 6-12 months; all patients were given aspirin.  The primary composite endpoint was cardiovascular death, myocardial infarction, or stroke.

Overall, the primary composite endpoint occurred in fewer patients in the ticagrelor group than in the clopidogrel group (hazard ratio 0.84, p=0.0025).  In one of the trial’s secondary endpoints, all-cause mortality was also seen to be reduced with ticagrelor (4.5% vs 5.9%; P<0.001).  However, no difference was seen between the ticagrelor and clopidogrel groups in the rates of either total major bleeding (p=0.88) or severe bleeding (p=0.38).

Conclusions:

In acute coronary syndromes undergoing PCI, use of ticagrelor instead of clopidogrel led to a significant reduction in the primary composite endpoint of cardiovascular death, myocardial infarction, or stroke.

• Cannon CP, Harrington RA, James S, Ardissino D, Becker RC, Emanuelsson H, et al. Comparison of ticagrelor with clopidogrel in patients with a planned invasive strategy for acute coronary syndromes (PLATO): A randomised double-blind study. Lancet 2010, Jan 23;375(9711):283-93.