New Study Shows Post-CABG Bleeds, Infections Lower With Ticagrelor Than Clopidogrel

Among patients undergoing coronary artery bypass graft surgery (CABG) after an acute coronary syndrome (ACS), the antiplatelet agent ticagrelor is associated with fewer cardiovascular-related deaths when compared to clopidogrel.

The differences are accounted for by fewer bleeding and infection events leading to death, according to a study published Sept. 26 in the Journal of the American College of Cardiology.

The current PLATO analysis investigated the causes of all CABG-related deaths and found that clopidogrel had more vascular deaths related to myocardial infarction (MI), heart failure, sudden death/arrhythmia and hemorrhagic stroke/bleeding than ticagrelor, but the difference was not statistically significant. Similarly, there were more nonvascular deaths with clopidogrel, but the difference was also not statistically significant. Bleeding and infection events, however, as direct or contributing causes of death were significantly more common statistically among clopidogrel-treated patients (bleeding events: 27 vs. nine patients, p < 0.01).

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The PLATO trial of patients with ACS, found that ticagrelor was superior to clopidogrel for reductions in cardiovascular events — including MI, cardiovascular death and stent thrombosis — and total death. Ticagrelor also was also found to be associated with a 50 percent relative reduction in total and cardiovascular-related deaths among these patients. However, these differences have not been well understood.

Investigators concluded that among "ACS patients receiving dual antiplatelet therapy within seven days of CABG, ticagrelor, compared with clopidogrel, was associated with fewer deaths related to cardiovascular, bleeding and infection events … [but] further studies are needed to investigate the underlying mechanisms responsible for the better survival."

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