4.5 Review

A Comprehensive Review of the Pleiotropic Effects of Ticagrelor

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Comparative Safety and Effectiveness of Loading Doses of P2Y12 Inhibitors in Patients Undergoing Elective PCI: a Network Meta-analysis

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Summary: This study aimed to compare the safety and efficacy of different loading strategies of P2Y12 inhibitors in patients undergoing elective PCI. The results showed that although prasugrel and ticagrelor are known as more potent antiplatelet agents, their effects in preventing MI and stroke are marginal and do not translate into improved overall mortality and bleeding compared with clopidogrel.

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Anne H. Tavenier et al.

Summary: The study found that intravenous acetaminophen compared with intravenous fentanyl did not significantly affect platelet inhibition in patients with ST-elevation myocardial infarction (STEMI). However, acetaminophen resulted in significantly higher plasma levels of ticagrelor and provided effective pain relief.

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Ischemic and Bleeding Outcomes of Potent P2Y12 Inhibitor Antiplatelet Agents Versus Clopidogrel in Elderly Patients With Acute Coronary Syndrome: A Meta-Analysis of Randomized Trials

Waiel Abusnina et al.

Summary: This meta-analysis aimed to investigate the efficacy and safety of potent oral P2Y12 inhibitors vs. clopidogrel in elderly patients with ACS. The results showed that compared to clopidogrel, the use of potent oral P2Y12 inhibitors was associated with a reduction in cardiovascular mortality, but no significant change in MACE outcomes, and an increased risk of bleeding events.

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Optimal P2Y12 inhibition in older adults with acute coronary syndromes: a network meta-analysis of randomized controlled trials

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Summary: This study aimed to examine the effect of available P2Y12 inhibitors on ischaemic and bleeding endpoints in older adults with ACS. The results showed that prasugrel was associated with a reduction in ischaemic events, while clopidogrel was associated with a reduction in bleeding events. Ticagrelor had the best effect on reducing stent thrombosis, but may not be the optimal choice for older adults.

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Ticagrelor and the risk of Staphylococcus aureus bacteraemia and other infections

Jawad H. Butt et al.

Summary: This study investigated the 1-year risks of Staphylococcus aureus bacteraemia, sepsis, and pneumonia in patients undergoing percutaneous coronary intervention and treated with ticagrelor or clopidogrel. The results showed that treatment with ticagrelor was associated with significantly lower risks of Staphylococcus aureus bacteraemia, sepsis, and pneumonia compared to treatment with clopidogrel.

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Impact of white blood cell count on clinical outcomes in patients treated with aspirin-free ticagrelor monotherapy after percutaneous coronary intervention: insights from the GLOBAL LEADERS trial

Masafumi Ono et al.

Summary: This study investigated the efficacy and safety of ticagrelor monotherapy in patients undergoing percutaneous coronary intervention (PCI) stratified according to their baseline white blood cell (WBC) count. The findings showed that ticagrelor monotherapy was more effective than aspirin monotherapy in reducing the primary endpoint in patients with lower WBC counts. However, there was no significant difference in the effectiveness of the two treatment strategies in patients with higher WBC counts, and there were no significant differences in bleeding risks between the two strategies regardless of the WBC groups.

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Summary: This study aimed to evaluate the effect of ticagrelor monotherapy after short-term dual-antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) on mortality. The results showed that ticagrelor monotherapy was associated with decreased all-cause mortality and bleeding risk without increasing the risk of cardiac death, ischemic stroke, acute myocardial infarction, and stent thrombosis.

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Do We Really Need Aspirin Loading for STEMI?

Regina Ye et al.

Summary: Aspirin loading is recommended for patients with ST elevation myocardial infarction (STEMI) as soon as possible after presentation, but its effects on the therapeutic effects of other medications have not been studied. This review suggests that aspirin loading may attenuate the protective effects of statins, ticagrelor, morphine, and postconditioning in reducing myocardial infarct size. Further research is needed to investigate the effects of aspirin loading on these medications and to compare aspirin loading with alternative antiplatelet regimens in STEMI patients.

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Niklas Bergh et al.

Summary: This review compares the efficacy and safety of clopidogrel and ticagrelor as part of dual antiplatelet therapy in patients with acute coronary syndrome and older patients. The results show that there is little or no difference in all-cause mortality between the two drugs. Although not evident in older patients, it cannot be excluded that clopidogrel may be slightly less efficient in reducing the risk of cardiovascular mortality and myocardial infarction, whereas ticagrelor is probably more efficacious in reducing the risk of stent thrombosis. Clopidogrel results in a reduced risk of dyspnea and clinically significant bleeding, and in older people probably in a reduced risk of major bleeding.

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Comparison of Ticagrelor With Clopidogrel in East Asian Patients With Acute Coronary Syndrome: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

Ying Ma et al.

Summary: This study aimed to evaluate the impact of choosing ticagrelor or clopidogrel on bleeding risk and efficacy in East Asian patients with acute coronary syndrome. The results showed that compared to clopidogrel, ticagrelor had a higher risk of any bleeding, PLATO major bleeding, and dyspnea, but significantly reduced the risk of stent thrombosis.

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Comparison of Clinical Outcomes Between Ticagrelor and Clopidogrel in Acute Coronary Syndrome: A Comprehensive Meta-Analysis

Mengyi Sun et al.

Summary: This study compared the clinical outcomes of ticagrelor and clopidogrel in patients with ACS. The results showed that ticagrelor is not superior to clopidogrel in terms of MACE, but is associated with a higher risk of bleeding. Different PCI strategies, ethnicities, and countries may contribute to the different therapeutic effects of ticagrelor.

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Ticagrelor improves systemic immune-inflammation index in acute coronary syndrome patients

Mehmet Koray Adali et al.

Summary: In this study, it was found that inflammatory parameters, including NLR, MHR, PLR, and SII, were significantly lower in ACS patients treated with ticagrelor compared to clopidogrel. This suggests that ticagrelor may have a positive impact on inflammatory response in PCI-treated ACS patients.

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Effect of CYP2C19 genetic polymorphism on the pharmacodynamics and clinical outcomes for patients treated with ticagrelor: a systematic review with qualitative and quantitative meta-analysis

Qiufen Xie et al.

Summary: This study systematically reviewed the impact of CYP2C19 genotype on the pharmacodynamics and clinical outcomes of ticagrelor. The results indicated that Asian patients carrying any CYP2C19 loss-of-function allele might have a lower risk of bleeding events compared with non-carriers. However, the role of CYP2C19 genotype in the overall risk of pharmacodynamics and clinical endpoints was not significant.

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Time Course for Benefit and Risk of Ticagrelor and Aspirin in Acute Ischemic Stroke or Transient Ischemic Attack

Yongjun Wang et al.

Summary: This study investigated the short-term benefits and risks of ticagrelor with aspirin in patients with acute mild-moderate ischemic stroke or high-risk TIA. The results showed that ticagrelor significantly reduced major ischemic events from the first week and continued throughout the 30-day treatment period, while the risk of major hemorrhage increased in the first week and remained relatively stable thereafter.

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Cardioprotective effect of extracellular vesicles derived from ticagrelor-pretreated cardiomyocyte on hyperglycemic cardiomyocytes through alleviation of oxidative and endoplasmic reticulum stress

Ceylan Verda Bitirim et al.

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Dominick J. Angiolillo et al.

Summary: Antiplatelet therapy is crucial for reducing thrombotic complications and ischemic events in patients undergoing percutaneous coronary interventions (PCI), but it is also associated with increased risk of bleeding. Advances in stent technologies and understanding of bleeding risks have led to the development of personalized antiplatelet treatment regimens. Recent research and guidelines have provided several options for antiplatelet therapy after PCI.

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2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation

Jean-Philippe Collet et al.

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Lina Badimon et al.

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Age-Dependent Effect of Ticagrelor Monotherapy Versus Ticagrelor With Aspirin on Major Bleeding and Cardiovascular Events: A Post Hoc Analysis of the TICO Randomized Trial

Byung Gyu Kim et al.

Summary: The study examined the age-dependent effects of ticagrelor monotherapy after 3-month DAPT compared to ticagrelor-based 12-month DAPT in patients with acute coronary syndrome. The results showed a greater reduction in major bleeding and cardiovascular events with ticagrelor monotherapy in patients aged 64 and older, indicating this strategy may be more beneficial for elderly patients with acute coronary syndrome.

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Comparison of Safety and Efficacy Between Clopidogrel and Ticagrelor in Elderly Patients With Acute Coronary Syndrome: A Systematic Review and Meta-Analysis

Xiangkai Zhao et al.

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Francesco Condello et al.

Summary: Among patients undergoing complex PCI, ticagrelor monotherapy after a short course of ticagrelor-based DAPT significantly reduced bleeding risk without increasing ischemic risk. More data are needed to definitively explain mortality benefits.

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Marie V. Hjortbak et al.

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