![]() ![]() Medications: Aspirin 99.8%, statin 93%, beta-blocker 82%, ACE-inhibitor or ARB 81%.CKD with creatinine clearance 1 previous MI 16%, CKD (eGFRPrimary outcome: CV mortality, MI, or stroke.Ticagrelor orally, 60 mg twice daily (n=7,045).Ticagrelor orally, 90 mg twice daily (n=7,050).Multicenter, double-blind, randomized, placebo-controlled trial.Do not give prasugrel if history of stroke/TIA (COR III/harm, LOE B-R).If DES placed and on DAPT, those with high risk of bleeding (e.g., oral anticoagulants), high risk for bleeding complication (major intracranial surgery), or significant overt bleeding, discontinuation of P2Y 12 inhibitor therapy after 6 mo may be reasonable (COR IIb, LOE C-LD).If coronary stent placed, tolerance of DAPT, no bleeding complications, no elevated risk of bleeding, continuation of DAPT for >12 mo may be reasonable (COR IIb, LOE A).If not at a high risk for bleeding complications and no history of stroke/TIA, it is reasonable to choose prasugrel over clopidogrel for maintenance P2Y 12 inhibitor therapy (COR IIa, LOE B-R).Ticagrelor may be preferable to clopidogrel for maintenance P2Y 12 inhibitor therapy (COR IIa, LOE B-R).If BMS or DES, treat with DAPT, including a P2Y 12 inhibitor (clopidogrel, prasugrel, or ticagrelor) for ≥12 mo (COR I, LOE B-R).If DES and high-risk for bleeding, high risk for bleeding complication (major intracranial surgery), or significant overt bleeding, discontinuation of P2Y 12 after 3 mo may be reasonable (COR IIB, LOE C-LD).If BMS or DES and good tolerance of DAPT and not high bleeding risk, continuing DAPT beyond the 1 or 6 month duration may be reasonable (COR IIb, LOE A).If DES, treat with DAPT, including a P2Y 12 inhibitor for ≥6 months (COR I, LOE B-R). ![]() If BMS, treat with DAPT, including a P2Y 12 inhibitor for ≥1 month (COR I, LOE A).If stable ischemic heart disease treated with PCI:.The dose of ASA 81 mg recommended in DAPT (COR I, LOE B-NR). ![]() Extended therapy with aspirin and clopidogrel after MI was explored in DAPT. The study reported that ticagrelor reduced the rate of death from vascular causes, MI, or stroke in patients who have an acute coronary syndrome as compared to clopidogrel. It is important to note that patients in the trial were at a high risk of ischemic events and those with recent bleeding or requirement for oral anticoagulants were excluded.Īnother study on ticagrelor is the PLATO. However, the risk of TIMI major and minor bleeding are significantly increased. The study showed that ticagrelor (90 mg or 60 mg, twice daily dose) significantly reduced the risk of cardiovascular death, MI, or stroke. Published 2015, the Prevention of Cardiovascular Events in Patients with Prior Heart Attack Using Ticagrelor Compared to Placebo on a Background of Aspirin-Thrombolysis in Myocardial Infarction 54 (PEGASUS-TIMI 54) trial randomized 21,162 patients who had prior MI 1-3 years earlier to receive ticagrelor (90 mg or 60 mg, twice daily) or placebo. Ticagrelor is a reversible P2Y 12 receptor antagonist which has been reported to be more effective and more rapid in inhibiting platelet aggregation as compared to clopidogrel. In patients who had prior MI 1-3 years earlier, ticagrelor (90 mg or 60 mg, twice daily) in combination with ASA significantly reduced the risk of cardiovascular death, MI, or stroke. In patients who had an MI in the prior 1-3 years, does ticagrelor+ASA reduce the risk of cardiovascular death, myocardial infarction, or stroke as compared to placebo? ![]()
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