Journal Article

Age- and Sex-Specific Disparities in Outcomes After Ticagrelor Versus Clopidogrel in East Asian Patients

Cha, Sung Joo, Kim, Ah-Ram, Kim, Ju Hyeon, Kim, Taesun, Oh, Hyeon Jeong, Ahn, Jung-Min, Lee, Junghoon, Lee, Jeen Hwa, Lee, Yeon Jeong, Kang, Do-Yoon, Lee, Pil Hyung, Park, Seung-Jung, Kim, Sehee, Jang, Mi Hee, Park, Duk-Woo, Kim, Tae Oh

2023

Overview

It is unknown whether there are age- and gender-related differences in the safety and efficacy of potent P2Y12 inhibitors in East Asian populations with a different bleeding or ischemic propensity. Using data from the TICAKOREA (Ticagrelor Versus Clopidogrel in Asian/Korean Patients with ACS Intended for Invasive Management) trial comparing ticagrelor versus clopidogrel for 800 Korean patients with acute coronary syndrome, the safety and efficacy outcomes were compared according to age (<75 vs ≥75 years) and gender (men vs women). The primary bleeding end point was clinically significant bleeding, and the primary ischemic end point was a major adverse cardiovascular event (MACE) at 12 months. The incidences of clinically significant bleeding were significantly higher after ticagrelor than after clopidogrel in patients aged <75 years (adjusted hazard ratio [HR] 2.56, 95% confidence interval [CI] 1.40 to 4.67) but not in patients aged ≥75 years (adjusted HR 1.1, 95% CI 0.40 to 3.38). The incidences of MACEs were significantly higher after ticagrelor than after clopidogrel in patients aged ≥75 years (adjusted HR 6.14, 95% CI 1.40 to 26.90) but not in patients aged <75 years (adjusted HR 0.93, 95% CI 0.50 to 1.73). The incidences of clinically significant bleeding were significantly higher after ticagrelor than after clopidogrel in men (adjusted HR 2.69, 95% CI 1.38 to 5.24) but not in women (adjusted HR 1.49, 95% CI 0.64 to 3.46). The adjusted risks of MACEs after ticagrelor or clopidogrel were not significantly different between men and women. In conclusion, there were substantial age- and gender-related differences in bleeding and ischemic outcomes after ticagrelor or clopidogrel in Korean patients with acute coronary syndrome. Clinical Trial Registration: URL: https://www.clinicaltrials.gov Unique identifier: NCT02094963.

• Publisher: Elsevier Inc,Elsevier Limited
• Subject: Acute Coronary Syndrome - drug therapy / Acute coronary syndromes / Age / Aged / antiplatelets / Bleeding / bleeding events / Clopidogrel / Clopidogrel - therapeutic use / East Asian People / Effectiveness / Female / Gender / Hemorrhage - chemically induced / Hemorrhage - epidemiology / Humans / Ischemia / ischemic events / Male / Men / Patients / Percutaneous Coronary Intervention / Platelet Aggregation Inhibitors - therapeutic use / Purinergic P2Y Receptor Antagonists - therapeutic use / Safety / Sex differences / Stroke / Thrombosis / Ticagrelor - therapeutic use / Treatment Outcome / Women