8/10/2023 0 Comments Pegasus brilintaRates of TIMI major bleeding were higher with ticagrelor (2.60 % for 90 mg, 2.30 % for 60 mg and 1.06 % for placebo, p < 0.001 for each dose against placebo) the rates of intracranial hemorrhage or fatal bleeding were 0.63 %, 0.71 % and 0.60 % in the 3 arms, respectively. The primary safety endpoint was TIMI major bleeding.īoth doses of ticagrelor significantly reduced the primary combined efficacy endpoint compared to placebo with Kaplan-Meier rates at 3 years of 7.85 % with ticagrelor 90 mg, 7.77 % with ticagrelor 60 mg, and 9.04 % with placebo (HR for ticagrelor 90 mg vs placebo 0.85, 95% CI 0.75-0.96, p = 0.0080 HR for ticagrelor 60 mg vs placebo 0.84, 95% CI 0.74-0.95, p = 0.0043). The primary efficacy endpoint was the composite of cardiovascular death, myocardial infarction, or stroke. We randomized 21,162 patients with a history of myocardial infarction within the prior 1-3 years in a double-blind 1 : 1 : 1 fashion to ticagrelor 90 mg twice daily, ticagrelor 60 mg twice daily, or placebo, all with low-dose aspirin, and followed them for a median of 33 months. The efficacy and safety of long-term ticagrelor therapy beyond 1 year after a myocardial infarction is unknown. 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.Ticagrelor is a P2Y12 receptor antagonist that has been shown to reduce ischemic events for up to a year after an acute coronary syndrome. “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. Sabatine, MD, MPH, FACC, the lead investigator for the study. “The benefit we saw was remarkably consistent across the individual components of the endpoint and in all the major subgroups of patients,” said Marc S. The study is the first to follow patients for more than one year. In addition, while the two doses of ticagrelor had similar overall efficacy, bleeding and other side effects tended to be less frequent with the 60 mg bid dose. In terms of bleeding, study investigators did note that ticagrelor increased the risk of TIMI major bleeding, but not fatal bleeding or intracerebral hemorrhage. Patients in the 90-mg group saw their risk of a second cardiac event decrease by 15 percent and patients in the 60-mg group saw their risk reduced by 16 percent as compared to the placebo patient group. Overall results found that both patient populations receiving ticagrelor in addition to aspirin had reduced chances of cardiovascular mortality, heart attack or stroke. All patients had additional risk factors such as age or diabetes, and had experienced their heart attack one to three years prior to participating in the study. The double-blind study looked at 21,162 patients with a history of myocardial infarction (MI) from 1,144 health care providers in 31 countries who were randomly assigned to a twice-daily regimen of ticagrelor at 90 mg, ticagrelor at 60 mg or placebo. Stable heart attack patients prescribed ticagrelor in addition to low-dose aspirin have lower risks of experiencing a secondary cardiac event, death or stroke, even after one year, according to the results of the PEGASUS-TIMI 54 Trial presented on Saturday, March 14 as part of ACC.15 and simultaneously published in the New England Journal of Medicine.
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