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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003ETicagrelor significantly reduced the risk of cardiovascular events and death without increasing major bleeding compared with clopidogrel in patients with acute coronary syndrome, according to findings from the Study of Platelet Inhibition and Patient Outcomes [PLATO; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00391872\u0026amp;atom=%2Fspmdc%2F9%2F4%2F16.atom\u0022\u003ENCT00391872\u003C\/a\u003E].\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ECoronary Artery Disease Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EMyocardial Infarction\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003ETicagrelor significantly reduced the risk of cardiovascular (CV) events and death without increasing major bleeding compared with clopidogrel in patients with acute coronary syndrome (ACS), according to findings from the Study of Platelet Inhibition and Patient Outcomes (PLATO; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00391872\u0026amp;atom=%2Fspmdc%2F9%2F4%2F16.atom\u0022\u003ENCT00391872\u003C\/a\u003E).\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003ETicagrelor is an investigational oral antiplatelet agent that directly and reversibly inhibits the adenosine diphosphate receptor P2Y12. Professor Lars Wallentin, MD, PhD, Uppsala Clinical Research Center, Uppsala, Sweden, reported findings from PLATO, which was designed to evaluate whether ticagrelor is superior to clopidogrel -currently a component of standard therapy for ACS -in preventing vascular events and death in a broad population of patients.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EPLATO randomized 18,624 patients who were hospitalized with ACS with or without ST-segment elevation to ticagrelor (180-mg loading dose, 90 mg twice-daily thereafter) or clopidogrel (300-mg to 600-mg loading dose, 75 mg thereafter) in a double-blinded fashion and treated for up to 12 months. All patients were treated with background therapy of aspirin 75 to 100 mg\/day. The primary efficacy endpoint was a composite of CV death, myocardial infarction (MI), or stroke. The primary safety endpoint was major bleeding as defined by the trial.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EAt 12 months, ticagrelor reduced the primary endpoint from 11.7% to 9.8% compared with clopidogrel (HR, 0.84; p\u0026lt;0.001; \u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E). Ticagrelor also reduced the rates of predefined secondary endpoints compared with clopidogrel, including MI (5.8% vs 6.9%; HR, 0.84; p=0.005) and death from vascular causes (4.0% vs 5.1%; HR, 0.79; p=0.001). However, ticagrelor did not prevent stroke (1.5% vs 1.3%; p=0.22).\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/9\/4\/16\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Cumulative Kaplan-Meier Estimates of the Time to the First Adjudicated Occurrence of the Primary Efficacy Endpoint.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1361356512\u0022 data-figure-caption=\u0022Cumulative Kaplan-Meier Estimates of the Time to the First Adjudicated Occurrence of the Primary Efficacy Endpoint.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/9\/4\/16\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/9\/4\/16\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/9\/4\/16\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/11349\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-6\u0022 class=\u0022first-child\u0022\u003ECumulative Kaplan-Meier Estimates of the Time to the First Adjudicated Occurrence of the Primary Efficacy Endpoint.\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003ECopyright \u00a9 2009 Massachusetts Medical Society. All rights reserved.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-7\u0022\u003EThere was no significant difference in the rates of trial-defined major bleeding (11.6% with ticagrelor vs 11.2% with clopidogrel; p=0.43) or TIMI major bleeding (7.9% vs 7.7%; p=0.57). Ticagrelor was associated with increased rates of major bleeding that were not related to coronary artery bypass grafting (CABG), the secondary safety endpoint (4.5% vs 3.8%; p=0.03). There was no significant difference in CABG-related bleeding (7.4% vs. 7.9%; p=0.32).\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003EOverall adverse events were similar; however, ticagrelor was associated with more dyspnea (13.8% vs 7.8%; p\u0026lt;0.001). In addition, among patients who underwent Holter monitoring during the first week of treatment (n=2866), ventricular pauses \u22653 seconds were more frequently seen in those who were randomized to ticagrelor (5.8% vs 3.6%; p=0.01). This difference was not seen on repeat Holter at 30 days (2.1% vs 1.7%; p=0.52). Discontinuation due to adverse events occurred more frequently with ticagrelor compared with clopidogrel (7.4% vs 6.0%; p\u0026lt; 0.001).\u003C\/p\u003E\u003Cp id=\u0022p-9\u0022\u003EResults from PLATO were simultaneously published online in the \u003Cem\u003ENew England Journal of Medicine.\u003C\/em\u003E In an accompanying editorial, Professor Albert Sch\u00f6mig, MD, Deutsches Herzzentrum, Munich, Germany, highlighted important differences between PLATO and two other pivotal antiplatelet (P2Y12 receptor antagonists) trials: CURE with clopidogrel and TRITON-TIMI 38 with prasugrel. Of the three trials, PLATO was the only one to demonstrate a reduction in all-cause mortality with more potent platelet inhibition, reducing the risk of overall mortality compared with clopidogrel by 22% (4.5% vs 5.9%; p\u0026lt;0.001).\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2009 MD Conference Express\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/9\/4\/16.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzmisp\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzmisp\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}