Feature | March 26, 2015

Long-term Ticagrelor Cuts Risk of Future Events After Heart Attack

Significant benefit seen from continuing antiplatelet drug along with aspirin beyond one year

March 25, 2015 — Adding the antiplatelet drug ticagrelor (Brilinta) to aspirin as long-term therapy after a heart attack significantly reduced the rate of subsequent death from cardiovascular causes, heart attack or stroke, with the benefit appearing to accrue for nearly three years, according to a study presented at the 2015 American College of Cardiology (ACC) Annual Scientific Session.
 
The double-blind PEGASUS-TIMI 54 trial recruited 21,162 patients who had experienced a heart attack in the previous one to three years. Each had another factor, such as age or diabetes, that put them at risk for a second heart attack. The patients, from 1,144 sites in 31 countries, were randomly assigned to a twice-daily regimen of ticagrelor at 90 mg, ticagrelor at 60 mg or placebo.
 
Both ticagrelor doses reduced the chances of cardiovascular death, heart attack or stroke, the study’s primary endpoint, with a 15 percent reduction in the 90-mg group and a 16 percent reduction in the 60 mg group compared to the placebo group.
 
“The benefit we saw was remarkably consistent across the individual components of the endpoint and in all the major subgroups of patients,” said Marc Sabatine, M.D., M.P.H., chair of the TIMI Study Group, a senior physician in the Cardiovascular Division at Brigham and Women’s Hospital and Harvard Medical School in Boston, and the study’s principal investigator. “Moreover, we followed patients for an
average of just under three years, and our event curves continue to spread out over time, suggesting that the benefit continues to accrue over time.”
 
After a heart attack, standard practice calls for putting patients on a lifetime regimen of daily aspirin to prevent clotting and reduce the chance of another heart attack. Previous studies have shown a benefit in adding a second antiplatelet drug like ticagrelor, from a class called P2Y12 inhibitors, but they investigated the additional therapy for only a year, leaving unanswered the question of whether patients would benefit from continuing this treatment longer.
 
The twice-daily 90-mg dose of ticagrelor is already approved for patients with acute coronary syndrome. Researchers included a lower dose in this study, to study whether platelet inhibition needed two years after a heart attack might be different from what is needed two hours after a heart attack. Findings from a pharmacokinetic and pharmacodynamic substudy comparing the two dose levels will be presented at a later date.
 
With blood thinners such as ticagrelor, bleeding is the major side effect, and excess bleeding was seen in both treatment arms, though bleeding into the brain and fatal bleeding were not more common with ticagrelor, Sabatine said. Shortness of breath, called dyspnea, was more common with ticagrelor than placebo. Bleeding led to discontinuation of ticagrelor in about 7 percent of patients on the study drug, and dyspnea led to discontinuation of the study drug in about 5 percent of patients on the drug.
 
“Efficacy was virtually identical with both ticagrelor doses,” Sabatine said. “Risk of bleeding and dyspnea tended to be, as predicted, a bit more with the 90-mg than the 60-mg dose, but the trial wasn’t designed to compare those two dose levels.”
“Now that we have the evidence, when faced with a patient who has had a heart attack, based on these data, I would continue treatment with ticagrelor as long as the patient tolerated it,” Sabatine said.
 
AstraZeneca sponsored the trial and provided a grant to Brigham and Women’s Hospital. Sabatine has received honoraria from the company.
 
This study was simultaneously published online in the New England Journal of Medicine at the time of presentation.
 
For more information: acc.org
 

Related Content

Tryton Side Branch Stent Recognized With Premier Technology Breakthrough Award
News | Stents Bifurcation| September 21, 2017
September 21, 2017 — Cardinal Health and Tryton Medical Inc.
DISRUPT BTK Study Shows Positive Results With Lithoplasty in Calcified Lesions Below the Knee
News | Peripheral Artery Disease (PAD)| September 20, 2017
Shockwave Medical reported positive results from the DISRUPT BTK Study, which were presented at the annual...
Heart Failure Market to Surpass $16 Billion by 2026
News | Heart Failure| September 19, 2017
The heart failure space across the seven key markets of the U.S., France, Germany, Italy, Spain, the U.K. and Japan is...
Corindus Announces First Patient Enrolled in PRECISION GRX Registry
News | Robotic Systems| September 18, 2017
September 18, 2017 — Corindus Vascular Robotics Inc.
Two-Year ILLUMENATE Trial Data Demonstrate Efficacy of Stellarex Drug-Coated Balloon
News | Drug-Eluting Balloons| September 18, 2017
Philips announced the two-year results from the ILLUMENATE European randomized clinical trial (EU RCT) demonstrating...
Sentinel Cerebral Protection System Significantly Reduces Stroke and Mortality in TAVR
News | Embolic Protection Devices| September 18, 2017
September 18, 2017 – Claret Medical announced publication of a new study in the...
Fysicon Receives FDA Approval for QMAPP Hemodynamic Monitoring System
Technology | Hemodynamic Monitoring Systems| September 18, 2017
Fysicon announced that it has been granted 510(k) clearance by the U.S. Food and Drug Administration (FDA) for its...
Peter Schneider, M.D. presents late breaking clinical trial results at VIVA 17 in Las Vegas. Panelists (l to r) Krishna Rocha-Singh, M.D., Sean Lyden, M.D., John Kaufman, M.D., Donna Buckley, M.D.

Peter Schneider, M.D. presents late breaking clinical trial results at VIVA 17 in Las Vegas. Panelists (l to r) Krishna Rocha-Singh, M.D., Sean Lyden, M.D., John Kaufman, M.D., Donna Buckley, M.D.

Feature | Cath Lab| September 14, 2017
September 14, 2017 — Here are quick summaries for all the key late-breaking vascular and endovascular clinical trials
Mississippi Surgical and Vascular Center Uses Toshiba Ultimax-i FPD to Save Patients' Limbs
News | Angiography| September 14, 2017
The southern U.S. sees some of the highest numbers of chronic medical conditions, such as peripheral artery disease...
Sponsored Content | Videos | Structural Heart Occluders| September 13, 2017
Ziyad Hijazi, M.D., MPH, MSCAI, FACC, director of the cardiac program and chair of the Department of Pediatrics at Si
Overlay Init