Ticagrelor in the treatment of acute coronary syndrome: An integrative review
DOI:
https://doi.org/10.33448/rsd-v13i8.46579Keywords:
Acute coronary syndrome; Heart attack; Ticagrelor.Abstract
Introduction - Acute Coronary Syndrome (ACS) represents a spectrum of acute cardiovascular conditions, encompassing Acute Myocardial Infarction (AMI) and Unstable Angina (UA). This medical emergency is characterized by the interruption of blood flow to the heart muscle, resulting from a partial or complete obstruction of the coronary artery. Ticagrelor is a P2Y12 inhibitor antiplatelet agent notable for its potency and efficacy in reducing cardiovascular events in patients with ACS. Objectives - This study aims to compile and evaluate current evidence, highlighting the effectiveness and/or superiority of Ticagrelor in relation to other therapeutic approaches. Methods - We carried out an integrative review of specialized literature, following stages of identifying objectives, planning protocol and search strategies on the EMBASE, Cochrane and MEDLINE platforms. Studies that addressed the pharmacological treatment of ACS were included, focusing on the use of Ticagrelor as the main therapeutic resource compared to other P2Y12 inhibitors. After selection and data extraction, 9 studies were analyzed. Results - Studies comparing Ticagrelor with Clopidogrel or Prasugrel in patients with ACS show similar results in the main outcomes, indicating equivalence between these medications. However, nuances in secondary outcomes reveal that Ticagrelor outperforms Clopidogrel in reducing stent thrombosis and cardiovascular death, but carries a greater risk of bleeding, especially in elderly patients. Conclusion - Ticagrelor has similar efficacy to Clopidogrel and Prasugrel in crucial cardiovascular outcomes. However, their in-depth analysis reveals a considerable risk of bleeding, especially in older patients.
References
Alexander, K. P., et al. (2006). Sex differences in major bleeding with glycoprotein IIb/IIIa inhibitors: Results from the CRUSADE (Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA guidelines) initiative. Circulation, 114(13), 1380-1387.
Andersson, C., et al. (2012). Association of clopidogrel treatment with risk of mortality and cardiovascular events following myocardial infarction in patients with and without diabetes. Journal of the American Medical Association, 308(8), 882-889.
Anima. (2014). Manual revisão bibliográfica sistemática integrativa: a pesquisa baseada em evidências. Grupo Anima.
Angiolillo, D. J., & Bernardo, E. (2005). Platelet function profiles in patients with type 2 diabetes and coronary artery disease on combined aspirin and clopidogrel treatment. Diabetes, 54(8), 2430-2435. https://doi.org/10.2337/diabetes.54.8.2430
Aradi, D., & Storey, R. F. (2010). Prognostic significance of high on-clopidogrel platelet reactivity after percutaneous coronary intervention: Systematic review and meta-analysis. American Heart Journal, 160(4), 543-551. https://doi.org/10.1016/j.ahj.2010.07.017
Bavishi, C., et al. (2015). Meta-analysis of comparison of the newer oral P2Y12 inhibitors (prasugrel or ticagrelor) to clopidogrel in patients with non-ST-elevation acute coronary syndrome. American Journal of Cardiology, 116(6), 809–817.
Biondi-Zoccai, G., et al. (2011). Adjusted indirect comparison meta-analysis of prasugrel versus ticagrelor for patients with acute coronary syndromes. International Journal of Cardiology, 150(3), 325–331.
Bonello, L., Arnaud, B., & Kownator, S. (2010). Consensus and future directions on the definition of high on-treatment platelet reactivity to adenosine diphosphate. Journal of the American College of Cardiology, 56(11), 919-933. https://doi.org/10.1016/j.jacc.2010.03.083
Bonello, L., et al. (2012). Ticagrelor or prasugrel versus clopidogrel in elderly patients with an acute coronary syndrome: Optimization of antiplatelet treatment in patients aged 70 years and older--rationale and design of the POPular AGE study. American Heart Journal, 163(5), 809-814.e1. https://doi.org/10.1016/j.ahj.2011.11.023
Bonello, L., et al. (2015). Comparison of ticagrelor versus prasugrel to prevent periprocedural myonecrosis in acute coronary syndromes. American Journal of Cardiology, 116(3), 339–343.
Botelho, L. L. R., Cunha, C. C. de A. & Macedo, M. (2011). O método da revisão integrativa nos estudos organizacionais. Gestão E Sociedade, Belo Horizonte-MG, Brasil.121-136.https://doi.org/10.21171/ges.v5i11.1220.
Capodanno, D., & Angiolillo, D. J. (2018). Diretrizes ACC/AHA versus ESC sobre terapia antiplaquetária dupla: Comparação das Diretrizes JACC. Journal of the American College of Cardiology, 71(20), 2317-2336. https://doi.org/10.1016/j.jacc.2018.03.016
Cannon, C. P., Harrington, R. A., James, S., et al. (2010). Comparison of ticagrelor with clopidogrel in patients with a planned invasive strategy for acute coronary syndromes (PLATO): A randomised double-blind study. The Lancet, 375(9711), 283-293. https://doi.org/10.1016/S0140-6736(09)62191-7
Cattaneo, M. (2015). P2Y12 receptors: Structure and function. Journal of Thrombosis and Haemostasis, 13(Suppl 1), S10-S16. https://doi.org/10.1111/jth.12952
Colwell, J. A., & Nesto, R. W. (2003). The platelet in diabetes: Focus on prevention of ischaemic events. Diabetes Care, 26(8), 2181-2188.
Crossetti, M. da G. O. (2012). Revisión integrativa de la investigación en enfermería, el rigor científico que se le exige.Revista Gaúcha De Enfermagem, 33(2),10–11.https://doi.org/10.1590/S1983-14472012000200002
Global Burden of Disease Study 2019 (GBD 2019) results. (n.d.). Global Health Data Exchange website. Institute for Health Metrics and Evaluation (IHME). Disponível em http://ghdx.healthdata.org/gbd-results-tool
Gagne, J. J., et al. (2013). Effect of smoking on comparative efficacy of antiplatelet agents: Systematic review, meta-analysis, and indirect comparison. BMJ, 347, f5307. https://doi.org/10.1136/bmj.f5307
Gimbel, M., Norgaard, B. L., & Steffel, J. (2020). Clopidogrel versus ticagrelor or prasugrel in patients aged 70 years or older with non-ST-elevation acute coronary syndrome (POPular AGE): The randomised, open-label, non-inferiority trial. The Lancet, 395(10233), 1374-1381. https://doi.org/10.1016/S0140-6736(20)30325-1
Guan, W., Lu, H., & Yang, K. (2018). Choosing between ticagrelor and clopidogrel following percutaneous coronary intervention: A systematic review and meta-analysis (2007-2017). Medicine (Baltimore), 97(43), e12978. https://doi.org/10.1097/MD.0000000000012978
Husted, S., et al. (2014). The efficacy of ticagrelor is maintained in women with acute coronary syndromes participating in the prospective, randomized, PLATelet inhibition and patient Outcomes (PLATO) trial. European Heart Journal, 35(24), 1541-1550.
James, S., Akerblom, A., Cannon, C. P., et al. (2009). Comparison of ticagrelor, the first reversible oral P2Y(12) receptor antagonist, with clopidogrel in patients with acute coronary syndromes: Rationale, design, and baseline characteristics of the PLATelet inhibition and patient Outcomes (PLATO) trial. American Heart Journal, 157(4), 599-605. https://doi.org/10.1016/j.ahj.2009.01.003
Järemo, P., & Hjemdahl, P. (2002). Individual variations of platelet inhibition after loading doses of clopidogrel. Journal of Internal Medicine, 252(3), 233-238. https://doi.org/10.1046/j.1365-2796.2002.01089.x
Jneid, H., et al. (2008). Sex differences in medical care and early death after acute myocardial infarction. Circulation, 118(25), 2803-2810.
Kang, H. J., et al. (2015). Ticagrelor versus clopidogrel in Asian patients with acute coronary syndrome: A retrospective analysis from the Platelet Inhibition and Patient Outcomes (PLATO) Trial. American Heart Journal, 169(6), 899–905.
Kim, E. S., Carrigan, T. P., & Menon, V. (2008). Enrollment of women in National Heart, Lung, and Blood Institute-funded cardiovascular randomized controlled trials fails to meet current federal mandates for inclusion. Journal of the American College of Cardiology, 52(8), 672-673.
Laine, M., Hulot, J. S., & Montalescot, G. (2014). Ticagrelor versus prasugrel in diabetic patients with an acute coronary syndrome: A pharmacodynamic randomised study. Thrombosis and Haemostasis, 111(2), 273-278. https://doi.org/10.1160/TH13-05-0384
Lahu, S., Agewall, S., & Darius, H. (2021). Efficacy and safety of ticagrelor versus prasugrel in smokers and nonsmokers with acute coronary syndromes. International Journal of Cardiology, 338, 8-13. https://doi.org/10.1016/j.ijcard.2021.06.011
Levine, G. N., et al. (2016). 2016 ACC/AHA guideline focused update on duration of dual antiplatelet therapy in patients with coronary artery disease: A report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines. Circulation, 134(10), e123–e155. https://doi.org/10.1161/CIR.0000000000000404
Li, J., et al. (2016). Population pharmacokinetics of ticagrelor in patients with acute coronary syndromes. International Journal of Clinical Pharmacology and Therapeutics, 54(8), 666–674.
Larmore, C., et al. (2016). "Real-world" comparison of prasugrel with ticagrelor in patients with acute coronary syndrome treated with percutaneous coronary intervention in the United States. Catheterization and Cardiovascular Interventions, 88(4), 535–544.
Montalescot, G., et al. (2014). Prehospital ticagrelor in ST-segment elevation myocardial infarction. New England Journal of Medicine, 371(11), 1016-1027. https://doi.org/10.1056/NEJMoa1407024
Mehta, S. R., et al. (2010). Ticagrelor versus clopidogrel in patients with acute coronary syndromes. New England Journal of Medicine, 363(11), 1009-1017. https://doi.org/10.1056/NEJMoa1006481
Patti, G., et al. (2014). Platelet function and long-term antiplatelet therapy in women: Is there a gender specificity? A ‘state-of-the-art’ paper. European Heart Journal, 35(35), 2213-2223.
Snyder, H. (2019). Literature review as a research methodology: An overview and guidelines. Journal of Business Research, 104(1), 333-339.https://ideas.repec.org/a/eee/jbrese/v104y2019icp333-339.html
Steiner, S., et al. (2012). Network meta-analysis of prasugrel, ticagrelor, high- and standard-dose clopidogrel in patients scheduled for percutaneous coronary interventions. Thrombosis and Haemostasis, 108(2), 318–327.
Storey, R. F., et al. (2010). Incidence of dyspnea and assessment of cardiac and pulmonary function in patients with stable coronary artery disease receiving ticagrelor, clopidogrel, or placebo in the ONSET/OFFSET study. Journal of the American College of Cardiology, 56(3), 185-193. https://doi.org/10.1016/j.jacc.2010.01.062
Storey, R. F., Husted, S., & James, S. K. (2007). Inibição da agregação plaquetária por AZD6140, um antagonista oral reversível do receptor P2Y12, em comparação com o clopidogrel em pacientes com síndromes coronarianas agudas. Journal of the American College of Cardiology, 50(18), 1752-1760. https://doi.org/10.1016/j.jacc.2007.07.046
Sun, M., et al. (2022). Comparison of clinical outcomes between ticagrelor and clopidogrel in acute coronary syndrome: A comprehensive meta-analysis. Frontiers in Cardiovascular Medicine, 8, 818215. https://doi.org/10.3389/fcvm.2021.818215
Valgimigli, M., et al. (2017). 2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS. Kardiologia Polska, 75(12), 1217–1299. https://doi.org/10.5603/KP.2017.0224
Wang, D., et al. (2018). Compared efficacy of clopidogrel and ticagrelor in treating acute coronary syndrome: A meta-analysis. BMC Cardiovascular Disorders, 18(1), 217. https://doi.org/10.1186/s12872-018-0948-4
Wang, T. Y., et al. (2012). Platelet biology and response to antiplatelet therapy in women: Implications for the development and use of antiplatelet pharmacotherapies for cardiovascular disease. Journal of the American College of Cardiology, 59(10), 891-900.
Wallentin, L., Becker, R. C., Budaj, A., et al. (2009). Ticagrelor versus clopidogrel in patients with acute coronary syndromes. New England Journal of Medicine, 361(11), 1045-1057. https://doi.org/10.1056/NEJMoa0904327
Watti, H., Saboo, S., & Gupta, V. (2017). Comparison of prasugrel and ticagrelor in patients with acute coronary syndrome undergoing percutaneous coronary intervention: A meta-analysis of randomized and non-randomized studies. International Journal of Cardiology, 249, 66-72. https://doi.org/10.1016/j.ijcard.2017.07.103
Wiviott, S. D., et al. (2007). Prasugrel versus clopidogrel in patients with acute coronary syndromes. New England Journal of Medicine, 357(20), 2001-2015. https://doi.org/10.1056/NEJMoa0706482
Zevin, S., et al. (2001). Cardiovascular effects of carbon monoxide and cigarette smoking. Journal of the American College of Cardiology, 38(6), 1633-1638. https://doi.org/10.1016/S0735-1097(01)01585-4
World Health Organization. (2013). Global action plan for the prevention and control of NCDs 2013-2020. WHO Library Cataloguing-In-Publication Data.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Sophia Kelly Abreu de Castro; Dayson de Assis Pereira ; Eric Azara Oliveira ; Léo Pedro Rufino ; Lucas Ribeiro Bubula
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
1) Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
2) Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
3) Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.
