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PLATO-Invasive: further evidence for benefit from ticagrelor
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 13 408 of the 18 624 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 (HR 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).
In patients with acute coronary syndromes undergoing PCI, use of ticagrelor instead of clopidogrel led to a significant reduction in the primary composite …