Clopidogrel vs Ticagrelor Real-World Efficacy in Patients With ACS Managed With PCI

A generic box of Clopidogrel tablets – white background.”rClopidogrel is an antiplatelet drug which reduces the “stickiness” of platelets in the blood to inhibit formation of blood clots in patients
Differences in mortality and MACE were evaluated in patients with ACS managed with PCI who were receiving ticagrelor or clopidogrel.

The following article is a part of conference coverage from the American College of Cardiology’s 71st Annual Scientific Session & Expo being held in Washington, DC, from April 2 to 4, 2022. The team at Cardiology Advisor will be reporting on the latest news and research conducted by clinicians and scientists in the field. Check back for more from the ACC 2022 .


Among patients treated with clopidogrel or ticagrelor for acute coronary syndrome (ACS) managed with percutaneous coronary intervention (PCI) in a real-world setting, no difference was found in major adverse cardiovascular events (MACE) or mortality at 12 months, according to research findings presented at the American College of Cardiology 71st Annual Scientific Session & Expo, from April 2nd through 4th, in Washington, DC.

While no difference in MACE or mortality was found in recent studies comparing clopidogrel with ticagrelor, an increase in major bleeding was observed in the patients receiving ticagrelor. In the PLATO trial, ticagrelor was shown to be more beneficial for patients with ACS than clopidogrel. Researchers sought to assess the effectiveness of these P2Y12 inhibitors by utilizing real-world data.

To accomplish this, they conducted a retrospective study of 3575 patients (1380 clopidogrel, 2196 ticagrelor) from January 2015 through December 2017, which included all local patients in a Canadian province diagnosed with ACS who received PCI. Comparing patients in the 2 cohorts was done statistically by creating 1229 propensity-score-matched pairs and utilizing stabilized inverse probability treatment weighting. The primary study outcome at 12 months was death, myocardial infarction, or unplanned revascularization. Major bleeding, death by any cause, any-cause hospitalization, or stroke were secondary study outcomes.

There was no difference for the 2 cohorts compared for MACE (HR 0.91; 0.74-1.12; P =.39), all-cause mortality (HR 1.00; 0.62-1.62; P =1.00), major bleeding, or stroke. The ticagrelor cohort showed a significant reduction in hospitalizations (HR 0.86; 0.71-0.99; P <.01). The clopidogrel cohort was older and significantly more likely to have chronic obstructive pulmonary disease, hypertension, chronic kidney disease, peripheral vascular disease, previous bleeding, previous ACS, and HAS-BLED score of 2 or higher.

Researchers concluded that real-world ACS patients managed with PCI and treated with clopidogrel or ticagrelor showed no difference at 12 months in MACE or mortality. The researchers noted, “These results suggest that a personalized approach to [duel antiplatelet therapy], taking into account comorbidities, ischemic, and bleeding risk may be preferable to routine use of ticagrelor in ACS patients.”


Wiens E, Leon SJ, Whitlock R, Tangri N, Shah A. Real-world efficacy and safety of dual antiplatelet therapy with ticagrelor as compared to clopidogrel in acute coronary syndrome patients treated with percutaneous coronary intervention. Presented at: American College of Cardiology 71st Annual Scientific Session & Expo; April 2-4, 2022; Washington, DC.

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