title: Stent thrombosis with ticagrelor versus clopidogrel in patients with acute coronary syndromes: an analysis from the prospective, randomized PLATO trial.
abstract: BACKGROUND
  We aimed to describe the effects of ticagrelor versus clopidogrel on stent thrombosis in the Platelet Inhibition and Patient Outcomes (PLATO) trial.
  
  
  RESULTS
  Of 18 624 patients hospitalized for acute coronary syndromes, 11 289 (61%) had at least 1 intracoronary stent. Ticagrelor reduced stent thrombosis compared with clopidogrel across all definitions: definite, 1.37% (n=71) versus 1.93% (n=105; hazard ratio [HR], 0.67; 95% confidence interval [CI], 0.50-0.90; P=0.0091); definite or probable, 2.21% (n=118) versus 2.87% (n=157; HR, 0.75; 95% CI, 0.59-0.95; P=0.017); and definite, probable, and possible, 2.94% (n=154) versus 3.77 (n=201; HR, 0.77; 95% CI, 0.62-0.95). The reduction in definite stent thrombosis was consistent regardless of acute coronary syndrome type, presence of diabetes mellitus, stent type (drug-eluting or bare metal stent), CYP2C19 genetic status, loading dose of aspirin, dose of clopidogrel before randomization, and use of glycoprotein IIb/IIIa inhibitors at randomization. The reduction in stent thrombosis with ticagrelor was numerically greater for late (>30 days; HR, 0.48; 95% CI, 0.24-0.96) and subacute (4 hours-30 days; HR, 0.60; 95% CI, 0.39-0.93) compared with acute (<24 hours; HR, 0.94; 95% CI, 0.43-2.05) stent thrombosis or for patients compliant to therapy (ie, taking blinded study treatment ≥80% of the time) compared with less compliant patients. Randomization to ticagrelor was a strong independent inverse predictor of definite stent thrombosis (HR, 0.65; 95% CI, 0.48-0.88).
  
  
  CONCLUSIONS
  Ticagrelor compared with clopidogrel reduces the incidence of stent thrombosis in patients with acute coronary syndromes, with consistent benefit across a broad range of patient, stent, and treatment characteristics.
authors.affiliation: INSERM-Unité 698, Hôpital Bichat, 46 Rue Henri Huchard, Paris, France. gabriel.steg@bch.aphp.fr
authors.forename: P Gabriel
authors.initials: PG
authors.lastname: Steg
authors.forename: Robert A
authors.initials: RA
authors.lastname: Harrington
authors.forename: Håkan
authors.initials: H
authors.lastname: Emanuelsson
authors.forename: Hugo A
authors.initials: HA
authors.lastname: Katus
authors.forename: Kenneth W
authors.initials: KW
authors.lastname: Mahaffey
authors.forename: Bernhard
authors.initials: B
authors.lastname: Meier
authors.forename: Robert F
authors.initials: RF
authors.lastname: Storey
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Wojdyla
authors.forename: Basil S
authors.initials: BS
authors.lastname: Lewis
authors.forename: Gerald
authors.initials: G
authors.lastname: Maurer
authors.forename: Lars
authors.initials: L
authors.lastname: Wallentin
authors.forename: Stefan K
authors.initials: SK
authors.lastname: James
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy* / Q000453:epidemiology / Q000601:surgery; D000241:Adenosine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000368:Aged; D000077144:Clopidogrel; D003328:Coronary Thrombosis / Q000188:drug therapy* / Q000453:epidemiology; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000188:drug therapy / Q000453:epidemiology; D006801:Humans; D038622:Internationality; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011446:Prospective Studies; D058921:Purinergic P2Y Receptor Antagonists / Q000627:therapeutic use; D012307:Risk Factors; D015607:Stents / Q000009:adverse effects*; D000077486:Ticagrelor; D013988:Ticlopidine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors; D058921:Purinergic P2Y Receptor Antagonists; D000077144:Clopidogrel; D000077486:Ticagrelor; D000241:Adenosine; D013988:Ticlopidine
keywords: blood platelets; stents; thrombosis