TY - JOUR
T1 - Premature Ticagrelor Discontinuation in Secondary Prevention of Atherosclerotic CVD
T2 - JACC Review Topic of the Week
AU - Arora, Sameer
AU - Shemisa, Kamal
AU - Vaduganathan, Muthiah
AU - Qamar, Arman
AU - Gupta, Ankur
AU - Garg, Sushil K.
AU - Kumbhani, Dharam J.
AU - Mayo, Helen
AU - Khalili, Houman
AU - Pandey, Ambarish
AU - Das, Sandeep R.
N1 - Publisher Copyright:
© 2019 American College of Cardiology Foundation
PY - 2019/5/21
Y1 - 2019/5/21
N2 - Ticagrelor is a cornerstone of modern antithrombotic therapy alongside aspirin in patients with acute coronary syndrome and after percutaneous coronary intervention. Adverse effects such as bleeding and dyspnea have been associated with premature ticagrelor discontinuation, which may limit any potential advantage of ticagrelor over clopidogrel. The randomized trials of ticagrelor captured adverse events, offering the opportunity to more precisely quantify these effects across studies. Therefore, a meta-analysis of 4 randomized clinical trials of ticagrelor conducted between January 2007 and June 2017 was performed to quantify the incidence and causes of premature ticagrelor discontinuation. Among 66,870 patients followed for a median 18 months, premature ticagrelor discontinuation was seen in 25%; bleeding was the most common cause of discontinuation followed by dyspnea. Versus the comparators, the relative risk of dyspnea-related discontinuation during follow-up was 6.4-fold higher, the relative risk of bleeding was 3.2-fold higher, and the relative risk of discontinuation due to any adverse event was 59% higher for patients receiving ticagrelor. Understanding these potential barriers to adherence to ticagrelor is crucial for informed patient-physician decision making and can inform future efforts to improve ticagrelor adherence. This review discusses the incidence, causes, and biological mechanisms of ticagrelor-related adverse effects and offers strategies to improve adherence to ticagrelor.
AB - Ticagrelor is a cornerstone of modern antithrombotic therapy alongside aspirin in patients with acute coronary syndrome and after percutaneous coronary intervention. Adverse effects such as bleeding and dyspnea have been associated with premature ticagrelor discontinuation, which may limit any potential advantage of ticagrelor over clopidogrel. The randomized trials of ticagrelor captured adverse events, offering the opportunity to more precisely quantify these effects across studies. Therefore, a meta-analysis of 4 randomized clinical trials of ticagrelor conducted between January 2007 and June 2017 was performed to quantify the incidence and causes of premature ticagrelor discontinuation. Among 66,870 patients followed for a median 18 months, premature ticagrelor discontinuation was seen in 25%; bleeding was the most common cause of discontinuation followed by dyspnea. Versus the comparators, the relative risk of dyspnea-related discontinuation during follow-up was 6.4-fold higher, the relative risk of bleeding was 3.2-fold higher, and the relative risk of discontinuation due to any adverse event was 59% higher for patients receiving ticagrelor. Understanding these potential barriers to adherence to ticagrelor is crucial for informed patient-physician decision making and can inform future efforts to improve ticagrelor adherence. This review discusses the incidence, causes, and biological mechanisms of ticagrelor-related adverse effects and offers strategies to improve adherence to ticagrelor.
KW - acute coronary syndrome
KW - adherence
KW - myocardial infarction
KW - secondary prevention
KW - ticagrelor
UR - http://www.scopus.com/inward/record.url?scp=85065099146&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85065099146&partnerID=8YFLogxK
U2 - 10.1016/j.jacc.2019.03.470
DO - 10.1016/j.jacc.2019.03.470
M3 - Review article
C2 - 31097167
AN - SCOPUS:85065099146
SN - 0735-1097
VL - 73
SP - 2454
EP - 2464
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 19
ER -