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news.AstraZeneca has reported results of a new analysis of PLATO (A Study of PLATelet Inhibition and Patient Outcomes) study which showed there were fewer deaths in patients with acute coronary syndromes (ACS) who took the investigational oral antiplatelet Brilinta (ticagrelor) within seven days prior to having heart bypass surgery (coronary artery bypass graft, CABG) compared to those who took clopidogrel.
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The data were presented at the American College of Cardiology (ACC) meeting in Atlanta, Georgia. The analysis included 1261 patients who were on study medication up to seven days prior to stopping study medication due to the need for urgent CABG surgery at any time after their ACS event.
The patients randomised to ticagrelor had a significantly lower rate of total and CV death than those randomised to clopidogrel treatment: Total mortality was reduced by 51% (RRR; p<0.01) with ticagrelor (4.6% of 632) compared to clopidogrel (9.2% of 629); CV death was reduced by 48% (RRR; p<0.01) with ticagrelor (4.0% of 632) compared to clopidogrel (7.5% of 629); Rate of the primary endpoint (composite of CV death, myocardial infarction, or stroke) from the time of CABG was 10.5% (66/632) with ticagrelor and 12.6% (79/629) with clopidogrel (HR 0.84; CI 0.60-1.16, p=0.29).
Additionally, there was no significant difference in CABG-related major bleeding for ticagrelor compared to clopidogrel, according to both the PLATO and TIMI bleeding criteria respectively (81% for ticagrelor vs. 80% for clopidogrel, and 59% for ticagrelor vs. 58% for clopidogrel for PLATO-defined and TIMI-defined, respectively).
Dr Claes Held, associate professor of Cardiology at the Uppsala Clinical Research Center and Department of Cardiology, and the sub-study’s lead researcher, said: “The CABG sub-analysis represents current clinical management of patients with ACS. The effects of ticagrelor compared to clopidogrel showed a reduction of total mortality by 51% and CV death by 48%. These treatment comparisons were consistent with the effects seen in the overall PLATO trial.”