EUCLID: Ticagrelor vs. Clopidogrel in Symptomatic PAD Patients
Ticagrelor did not demonstrate a benefit over clopidogrel in symptomatic peripheral artery disease (PAD) patients, according to the results of the EUCLID Trial presented Nov. 13 during AHA 2016 and simultaneously published in the New England Journal of Medicine.
Manesh R. Patel, MD, FACC, et al., conducted a double-blind, randomized investigation of 13,885 patients with PAD to evaluate the non-inferiority of ticagrelor vs. clopidogrel in preventing cardiovascular death, myocardial infarction (MI) or ischemic stroke. Participants were eligible if they had an ankle-brachial index of 0.80 or less, or had undergone previous revascularization of the lower limbs.
The results of the trial show that ticagrelor is not superior to clopidogrel for the reduction of cardiovascular events. The primary efficacy end point of composite cardiovascular death, MI or stroke occurred in 10.8 percent of patients receiving ticagrelor and in 10.6 percent of those receiving clopidogrel. Major bleeding occurred in 1.6 percent of patients.
In a separate investigation, also presented at AHA 2016 and simultaneously published in Circulation, W. Schuyler Jones, MD, et al., evaluated the non-inferiority of ticagrelor vs. clopidogrel in the 57 percent of PAD patients enrolled in the EUCLID Trial who had previously undergone lower extremity revascularization.
The authors found that this patient subset of the original cohort had higher rates of MI and acute limb ischemia with similar composite rates of cardiovascular death MI and stroke, compared to the patients enrolled based on the ankle-brachial index criterion. Further, ticagrelor did not prove superior to clopidogrel for the reduction of cardiovascular events in this patient group.
Keywords: AHA16, American Heart Association, AHA Annual Scientific Sessions, Adenosine, Aneurysm, Myocardial Infarction, Peripheral Arterial Disease, Stroke, Ticlopidine
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