Bleeding Risk and Incidence in Real World Percutaneous Coronary Intervention Patients with Ticagrelor (original) (raw)
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Journal of the American Heart Association, 2021
Background Ticagrelor reduces ischemic risk but increases bleeding in patients with prior myocardial infarction. Identification of patients at lower bleeding risk is important in selecting patients who are likely to derive more favorable outcomes versus risk from this strategy. Methods and Results PEGASUS‐TIMI 54 (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) randomized 21 162 patients with prior myocardial infarction in a 1:1:1 fashion to ticagrelor 60 mg or 90 mg twice daily or placebo, with ticagrelor 60 mg approved for long‐term use. TIMI major or minor bleeding was the primary end point for this analysis. Causes of bleeding were categorized by site and etiology, and independent predictors were identified. At 3 years, ticagrelor 60 mg increased the rate of TIMI major or minor bleeding by 2.0% versus placebo (1.4% placebo versus 3.4% ticagrelor). The...
Long-Term Use of Ticagrelor in Patients with Prior Myocardial Infarction
In their report on the PEGASUS-TIMI 54 (Prevention of Cardiovascular Events in Patients with Prior Heart Attack using Ticagrelor Compared to Placebo on the Background of Aspirin-Thrombolysis in Myocardial Infarction 54) trial, Bonaca et al. (May 7 issue)(1) suggest that the benefit of dual antiplatelet therapy comes at a cost of an increased risk of bleeding events. A dual antiplatelet regimen administered at an even lower dose than the one used in this study could confer a reduced risk of bleeding events and improved secondary prophylaxis against recurrent ischemic events as compared with aspirin. We successfully tested