Ticagrelor vs. Clopidogrel: Causes of Death in Acute Coronary Syndromes

the MPR take:

A new study published in the journal Heart sought out to examine specific causes of death, and whether infection and bleeding episodes contributed to death, in patients with acute coronary syndromes being treated with either ticagrelor or clopidogrel. Data on 905 patients who died post enrollment in the PLATelet inhibition and patient Outcomes trial (PLATO) was examined to find out what contributed to these deaths based on which treatment the patient had received.  There were significantly fewer sudden deaths in patients taking ticagrelor (0.7%) compared to clopidogrel (1.1%), however there was no significant difference in acute MI deaths (1.9% vs. 2.1%) or heart failure (0.3% vs. 0.5%) between the ticagrelor and clopidogrel groups, respectively. With regards to deaths directly caused by infection, there was no difference between the groups.  Ticagrelor-treated patients were at a lower risk where infection was either a direct cause of death or contributed to the death (0.5% vs. 0.8% for clopidogrel).  The incidence of bleeding being the cause or contributing to the death of the patient did not differ between the two treatment groups (0.5% vs.0.5%). Based on study data, ticagrelor reduced cardiovascular mortality and total mortality (mainly by reduction in sudden death) compared to clopidogrel.

Causes of mortality with ticagrelor compared with clopidogrel in acute coronary syndromes
Causes of mortality with ticagrelor compared with clopidogrel in acute coronary syndromes
Objective To describe specific causes of death and evaluate whether bleeding events and infection contributed to mortality in all ticagrelor-treated and clopidogrel-treated patients with acute coronary syndromes. In the 905 patients who died postenrolment in the PLATO trial (n=18 624), reviewers, blinded to study treatment, subclassified direct causes of death and evaluated whether infection or bleeding events contributed to fatal events.

READ FULL ARTICLE From Heart - BMJ Journals