¿cuáles son las limitaciones de los nuevos antiagregantes?
TRANSCRIPT
![Page 1: ¿Cuáles son las limitaciones de los nuevos antiagregantes?](https://reader036.vdocuments.co/reader036/viewer/2022062309/5665b47c1a28abb57c91e715/html5/thumbnails/1.jpg)
¿Cuáles son las limitaciones de los
nuevos antiagregantes?
![Page 2: ¿Cuáles son las limitaciones de los nuevos antiagregantes?](https://reader036.vdocuments.co/reader036/viewer/2022062309/5665b47c1a28abb57c91e715/html5/thumbnails/2.jpg)
TIMI Major Bleeding TIMI Major Bleeding TRITON-TIMI 38 versus PLATOTRITON-TIMI 38 versus PLATO
Clopidogrel
Prasugrel
Wiviott SD et al., N Engl J Med 2007; Wallentin L et al., N Engl J Med 2009
P = 0.03
1.81.8
2.42.4
TRITON PLATO
Ticagrelor2.22.2
2.82.8
P = 0.03
0
1
3
2
Rate of non CABG bleeds (%)Rate of non CABG bleeds (%)
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0.5 1 2
OVERALL
Prasugrel Better Clopidogrel Better
No
YesPrior Stroke / TIA Pint = 0.006
<75
≥75Age
Pint = 0.18
≥60 kg
<60 kgWeight
Pint = 0.36
www.timi.org – Accessed on July 16, 2008
Contraindication with history of cerebro-vascular event
Hazard Ratio for net clinical outcome
TRITON-TIMI 38TRITON-TIMI 38
![Page 4: ¿Cuáles son las limitaciones de los nuevos antiagregantes?](https://reader036.vdocuments.co/reader036/viewer/2022062309/5665b47c1a28abb57c91e715/html5/thumbnails/4.jpg)
Ticagrelor better Clopidogrel better
Ti. Cl.Total
Patients
KM % atMonth 12
HR (95% CI)Hazard Ratio
(95% CI)
Yes
Yes
Revascularization History of CABG
Sex
Weight Group
≥65 Years
Characteristic
0.5 1.0 2.0
17256 9.5 11.2 0.86 (0.78, 0.94)<80 kg
1312 13.1 17.3 0.75 (0.60, 0.99)≥60 kg
5288 11.2 13.2 0.83 (0.71, 0.97)
<60 kg
13336 9.2 11.1 0.85 (0.76, 0.95)Female
2878 16.8 18.3 0.94 (0.78, 1.12)
Male
15744 8.6 10.4 0.82 (0.74, 0.91)≥75 Years
7979 13.2 16.0 0.83 (0.74, 0.94)<75 Years
10643 7.2 8.5 0.85 (0.74, 0.97)<65 Years
1152 19.0 20.8 0.87 (0.66, 1.13)Age Group
17462 9.2 11.1 0.84 (0.76, 0.93)No
1106 19.5 21.7 0.88 (0.67, 1.15)Previous TIA/Non-hemorrhagic Stroke
17518 9.2 11.0 0.84 (0.77, 0.93)No
Yes
Central/South America
≥80 kg
North America
1237 15.2 17.9 0.86 (0.65, 1.13)Europe/Middle East/Africa
1714 11.4 14.8 0.80 (0.61, 1.04)Asia/Australia
4662 14.1 16.2 0.88 (0.76, 1.03)Region
13962 8.4 10.2 0.83 (0.74, 0.92)No
9513 8.3 10.5 0.79 (0.69, 0.90)Medical History of DM
9055 11.4 12.8 0.90 (0.79, 1.01)
0.2
p- value(Interaction)
0.76
0.84
0.86
0.22
0.82
0.36
0.17
0.05
1814 11.9 9.6 1.25 (0.93, 1.67)13859 8.8 11.0 0.80 (0.72, 0.90)
0.49
Primary Endpoint in Pre-defined Subgroups (Cont’d)
Wallentin L, et al.New Engl J Med. 2009;361.
14
Ticagrelor better Clopidogrel better
Ti. Cl.Total
Patients
KM % atMonth 12
HR (95% CI)Hazard Ratio
(95% CI)
Yes
Yes
Revascularization History of CABG
Sex
Weight Group
≥65 Years
Characteristic
0.5 1.0 2.0
17256 9.5 11.2 0.86 (0.78, 0.94)<80 kg
1312 13.1 17.3 0.75 (0.60, 0.99)≥60 kg
5288 11.2 13.2 0.83 (0.71, 0.97)
<60 kg
13336 9.2 11.1 0.85 (0.76, 0.95)Female
2878 16.8 18.3 0.94 (0.78, 1.12)
Male
15744 8.6 10.4 0.82 (0.74, 0.91)≥75 Years
7979 13.2 16.0 0.83 (0.74, 0.94)<75 Years
10643 7.2 8.5 0.85 (0.74, 0.97)<65 Years
1152 19.0 20.8 0.87 (0.66, 1.13)Age Group
17462 9.2 11.1 0.84 (0.76, 0.93)No
1106 19.5 21.7 0.88 (0.67, 1.15)Previous TIA/Non-hemorrhagic Stroke
17518 9.2 11.0 0.84 (0.77, 0.93)No
Yes
Central/South America
≥80 kg
North America
1237 15.2 17.9 0.86 (0.65, 1.13)Europe/Middle East/Africa
1714 11.4 14.8 0.80 (0.61, 1.04)Asia/Australia
4662 14.1 16.2 0.88 (0.76, 1.03)Region
13962 8.4 10.2 0.83 (0.74, 0.92)No
9513 8.3 10.5 0.79 (0.69, 0.90)Medical History of DM
9055 11.4 12.8 0.90 (0.79, 1.01)
0.2
p- value(Interaction)
0.76
0.84
0.86
0.22
0.82
0.36
0.17
0.05
1814 11.9 9.6 1.25 (0.93, 1.67)13859 8.8 11.0 0.80 (0.72, 0.90)
0.49
Primary Endpoint in Pre-defined Subgroups (Cont’d)
Wallentin L, et al.New Engl J Med. 2009;361.
14
Ticagrelor better Clopidogrel better
Ti. Cl.Total
Patients
KM % atMonth 12
HR (95% CI)Hazard Ratio
(95% CI)
Yes
Yes
Revascularization History of CABG
Sex
Weight Group
≥65 Years
Characteristic
0.5 1.0 2.0
17256 9.5 11.2 0.86 (0.78, 0.94)<80 kg
1312 13.1 17.3 0.75 (0.60, 0.99)≥60 kg
5288 11.2 13.2 0.83 (0.71, 0.97)
<60 kg
13336 9.2 11.1 0.85 (0.76, 0.95)Female
2878 16.8 18.3 0.94 (0.78, 1.12)
Male
15744 8.6 10.4 0.82 (0.74, 0.91)≥75 Years
7979 13.2 16.0 0.83 (0.74, 0.94)<75 Years
10643 7.2 8.5 0.85 (0.74, 0.97)<65 Years
1152 19.0 20.8 0.87 (0.66, 1.13)Age Group
17462 9.2 11.1 0.84 (0.76, 0.93)No
1106 19.5 21.7 0.88 (0.67, 1.15)Previous TIA/Non-hemorrhagic Stroke
17518 9.2 11.0 0.84 (0.77, 0.93)No
Yes
Central/South America
≥80 kg
North America
1237 15.2 17.9 0.86 (0.65, 1.13)Europe/Middle East/Africa
1714 11.4 14.8 0.80 (0.61, 1.04)Asia/Australia
4662 14.1 16.2 0.88 (0.76, 1.03)Region
13962 8.4 10.2 0.83 (0.74, 0.92)No
9513 8.3 10.5 0.79 (0.69, 0.90)Medical History of DM
9055 11.4 12.8 0.90 (0.79, 1.01)
0.2
p- value(Interaction)
0.76
0.84
0.86
0.22
0.82
0.36
0.17
0.05
1814 11.9 9.6 1.25 (0.93, 1.67)13859 8.8 11.0 0.80 (0.72, 0.90)
0.49
Primary Endpoint in Pre-defined Subgroups (Cont’d)
Wallentin L, et al.New Engl J Med. 2009;361.
14
Ticagrelor better Clopidogrel better
Ti. Cl.Total
Patients
KM % atMonth 12
HR (95% CI)Hazard Ratio
(95% CI)
Yes
Yes
Revascularization History of CABG
Sex
Weight Group
≥65 Years
Characteristic
0.5 1.0 2.0
17256 9.5 11.2 0.86 (0.78, 0.94)<80 kg
1312 13.1 17.3 0.75 (0.60, 0.99)≥60 kg
5288 11.2 13.2 0.83 (0.71, 0.97)
<60 kg
13336 9.2 11.1 0.85 (0.76, 0.95)Female
2878 16.8 18.3 0.94 (0.78, 1.12)
Male
15744 8.6 10.4 0.82 (0.74, 0.91)≥75 Years
7979 13.2 16.0 0.83 (0.74, 0.94)<75 Years
10643 7.2 8.5 0.85 (0.74, 0.97)<65 Years
1152 19.0 20.8 0.87 (0.66, 1.13)Age Group
17462 9.2 11.1 0.84 (0.76, 0.93)No
1106 19.5 21.7 0.88 (0.67, 1.15)Previous TIA/Non-hemorrhagic Stroke
17518 9.2 11.0 0.84 (0.77, 0.93)No
Yes
Central/South America
≥80 kg
North America
1237 15.2 17.9 0.86 (0.65, 1.13)Europe/Middle East/Africa
1714 11.4 14.8 0.80 (0.61, 1.04)Asia/Australia
4662 14.1 16.2 0.88 (0.76, 1.03)Region
13962 8.4 10.2 0.83 (0.74, 0.92)No
9513 8.3 10.5 0.79 (0.69, 0.90)Medical History of DM
9055 11.4 12.8 0.90 (0.79, 1.01)
0.2
p- value(Interaction)
0.76
0.84
0.86
0.22
0.82
0.36
0.17
0.05
1814 11.9 9.6 1.25 (0.93, 1.67)13859 8.8 11.0 0.80 (0.72, 0.90)
0.49
Primary Endpoint in Pre-defined Subgroups (Cont’d)
Wallentin L, et al.New Engl J Med. 2009;361.
14
Ticagrelor better Clopidogrel better
Ti. Cl.Total
Patients
KM % atMonth 12
HR (95% CI)Hazard Ratio
(95% CI)
Yes
Yes
Revascularization History of CABG
Sex
Weight Group
≥65 Years
Characteristic
0.5 1.0 2.0
17256 9.5 11.2 0.86 (0.78, 0.94)<80 kg
1312 13.1 17.3 0.75 (0.60, 0.99)≥60 kg
5288 11.2 13.2 0.83 (0.71, 0.97)
<60 kg
13336 9.2 11.1 0.85 (0.76, 0.95)Female
2878 16.8 18.3 0.94 (0.78, 1.12)
Male
15744 8.6 10.4 0.82 (0.74, 0.91)≥75 Years
7979 13.2 16.0 0.83 (0.74, 0.94)<75 Years
10643 7.2 8.5 0.85 (0.74, 0.97)<65 Years
1152 19.0 20.8 0.87 (0.66, 1.13)Age Group
17462 9.2 11.1 0.84 (0.76, 0.93)No
1106 19.5 21.7 0.88 (0.67, 1.15)Previous TIA/Non-hemorrhagic Stroke
17518 9.2 11.0 0.84 (0.77, 0.93)No
Yes
Central/South America
≥80 kg
North America
1237 15.2 17.9 0.86 (0.65, 1.13)Europe/Middle East/Africa
1714 11.4 14.8 0.80 (0.61, 1.04)Asia/Australia
4662 14.1 16.2 0.88 (0.76, 1.03)Region
13962 8.4 10.2 0.83 (0.74, 0.92)No
9513 8.3 10.5 0.79 (0.69, 0.90)Medical History of DM
9055 11.4 12.8 0.90 (0.79, 1.01)
0.2
p- value(Interaction)
0.76
0.84
0.86
0.22
0.82
0.36
0.17
0.05
1814 11.9 9.6 1.25 (0.93, 1.67)13859 8.8 11.0 0.80 (0.72, 0.90)
0.49
Primary Endpoint in Pre-defined Subgroups (Cont’d)
Wallentin L, et al.New Engl J Med. 2009;361.
14Ticagrelor better Clopidogrel better
Ti. Cl.Total
Patients
KM % atMonth 12
HR (95% CI)Hazard Ratio
(95% CI)
Yes
Yes
Revascularization History of CABG
Sex
Weight Group
≥65 Years
Characteristic
0.5 1.0 2.0
17086 11.5 10.9 1.06 (0.96, 1.16)<80 kg
1296 12.6 15.2 0.82 (0.60, 1.12)≥60 kg
5237 10.7 10.5 1.01 (0.85, 1.21)
<60 kg
13184 11.9 11.4 1.05 (0.94, 1.16)Female
2846 14.2 13.3 1.04 (0.84, 1.29)
Male
15574 11.1 10.8 1.04 (0.94, 1.15)≥75 Years
7892 14.4 13.6 1.07 (0.95, 1.22)<75 Years
10528 9.5 9.5 1.00 (0.87, 1.13)<65 Years
1136 14.6 14.9 0.99 (0.71, 1.37)Age Group
17284 11.4 11.0 1.04 (0.95, 1.14)No
1092 7.3 7.8 0.94 (0.60, 1.49)Previous TIA/Non-hemorrhagic Stroke
17329 11.8 11.4 1.04 (0.95, 1.14)No
Yes
Central/South America
≥80 kg
North America
1230 15.6 13.2 1.22 (0.89, 1.66)Europe/Middle East/Africa
1692 10.6 10.8 1.03 (0.76, 1.40)Asia/Australia
4621 14.1 14.8 0.95 (0.81, 1.12)Region
13800 10.8 10.0 1.08 (0.97, 1.20)No
9423 11.4 10.5 1.08 (0.95, 1.23)Medical History of DM
8959 11.7 11.9 0.99 (0.88, 1.13)
0.2
P value(Interaction)
0.68
0.77
0.42
1.00
0.76
0.12
0.35
0.75
1752 12.9 12.2 1.06 (0.80, 1.40)13747 11.1 11.0 1.01 (0.91, 1.13)
0.21
HRs and cumulative incidence of major bleeding (pre-defined subgroups - cont’d)
Wallentin L, et al.New Engl J Med. 2009;361.15
Ticagrelor better Clopidogrel better
Ti. Cl.Total
Patients
KM % atMonth 12
HR (95% CI)Hazard Ratio
(95% CI)
Yes
Yes
Revascularization History of CABG
Sex
Weight Group
≥65 Years
Characteristic
0.5 1.0 2.0
17086 11.5 10.9 1.06 (0.96, 1.16)<80 kg
1296 12.6 15.2 0.82 (0.60, 1.12)≥60 kg
5237 10.7 10.5 1.01 (0.85, 1.21)
<60 kg
13184 11.9 11.4 1.05 (0.94, 1.16)Female
2846 14.2 13.3 1.04 (0.84, 1.29)
Male
15574 11.1 10.8 1.04 (0.94, 1.15)≥75 Years
7892 14.4 13.6 1.07 (0.95, 1.22)<75 Years
10528 9.5 9.5 1.00 (0.87, 1.13)<65 Years
1136 14.6 14.9 0.99 (0.71, 1.37)Age Group
17284 11.4 11.0 1.04 (0.95, 1.14)No
1092 7.3 7.8 0.94 (0.60, 1.49)Previous TIA/Non-hemorrhagic Stroke
17329 11.8 11.4 1.04 (0.95, 1.14)No
Yes
Central/South America
≥80 kg
North America
1230 15.6 13.2 1.22 (0.89, 1.66)Europe/Middle East/Africa
1692 10.6 10.8 1.03 (0.76, 1.40)Asia/Australia
4621 14.1 14.8 0.95 (0.81, 1.12)Region
13800 10.8 10.0 1.08 (0.97, 1.20)No
9423 11.4 10.5 1.08 (0.95, 1.23)Medical History of DM
8959 11.7 11.9 0.99 (0.88, 1.13)
0.2
P value(Interaction)
0.68
0.77
0.42
1.00
0.76
0.12
0.35
0.75
1752 12.9 12.2 1.06 (0.80, 1.40)13747 11.1 11.0 1.01 (0.91, 1.13)
0.21
HRs and cumulative incidence of major bleeding (pre-defined subgroups - cont’d)
Wallentin L, et al.New Engl J Med. 2009;361.15
Ticagrelor better Clopidogrel better
Ti. Cl.Total
Patients
KM % atMonth 12
HR (95% CI)Hazard Ratio
(95% CI)
Yes
Yes
Revascularization History of CABG
Sex
Weight Group
≥65 Years
Characteristic
0.5 1.0 2.0
17086 11.5 10.9 1.06 (0.96, 1.16)<80 kg
1296 12.6 15.2 0.82 (0.60, 1.12)≥60 kg
5237 10.7 10.5 1.01 (0.85, 1.21)
<60 kg
13184 11.9 11.4 1.05 (0.94, 1.16)Female
2846 14.2 13.3 1.04 (0.84, 1.29)
Male
15574 11.1 10.8 1.04 (0.94, 1.15)≥75 Years
7892 14.4 13.6 1.07 (0.95, 1.22)<75 Years
10528 9.5 9.5 1.00 (0.87, 1.13)<65 Years
1136 14.6 14.9 0.99 (0.71, 1.37)Age Group
17284 11.4 11.0 1.04 (0.95, 1.14)No
1092 7.3 7.8 0.94 (0.60, 1.49)Previous TIA/Non-hemorrhagic Stroke
17329 11.8 11.4 1.04 (0.95, 1.14)No
Yes
Central/South America
≥80 kg
North America
1230 15.6 13.2 1.22 (0.89, 1.66)Europe/Middle East/Africa
1692 10.6 10.8 1.03 (0.76, 1.40)Asia/Australia
4621 14.1 14.8 0.95 (0.81, 1.12)Region
13800 10.8 10.0 1.08 (0.97, 1.20)No
9423 11.4 10.5 1.08 (0.95, 1.23)Medical History of DM
8959 11.7 11.9 0.99 (0.88, 1.13)
0.2
P value(Interaction)
0.68
0.77
0.42
1.00
0.76
0.12
0.35
0.75
1752 12.9 12.2 1.06 (0.80, 1.40)13747 11.1 11.0 1.01 (0.91, 1.13)
0.21
HRs and cumulative incidence of major bleeding (pre-defined subgroups - cont’d)
Wallentin L, et al.New Engl J Med. 2009;361.15
Ticagrelor better Clopidogrel better
Ti. Cl.Total
Patients
KM % atMonth 12
HR (95% CI)Hazard Ratio
(95% CI)
Yes
Yes
Revascularization History of CABG
Sex
Weight Group
≥65 Years
Characteristic
0.5 1.0 2.0
17086 11.5 10.9 1.06 (0.96, 1.16)<80 kg
1296 12.6 15.2 0.82 (0.60, 1.12)≥60 kg
5237 10.7 10.5 1.01 (0.85, 1.21)
<60 kg
13184 11.9 11.4 1.05 (0.94, 1.16)Female
2846 14.2 13.3 1.04 (0.84, 1.29)
Male
15574 11.1 10.8 1.04 (0.94, 1.15)≥75 Years
7892 14.4 13.6 1.07 (0.95, 1.22)<75 Years
10528 9.5 9.5 1.00 (0.87, 1.13)<65 Years
1136 14.6 14.9 0.99 (0.71, 1.37)Age Group
17284 11.4 11.0 1.04 (0.95, 1.14)No
1092 7.3 7.8 0.94 (0.60, 1.49)Previous TIA/Non-hemorrhagic Stroke
17329 11.8 11.4 1.04 (0.95, 1.14)No
Yes
Central/South America
≥80 kg
North America
1230 15.6 13.2 1.22 (0.89, 1.66)Europe/Middle East/Africa
1692 10.6 10.8 1.03 (0.76, 1.40)Asia/Australia
4621 14.1 14.8 0.95 (0.81, 1.12)Region
13800 10.8 10.0 1.08 (0.97, 1.20)No
9423 11.4 10.5 1.08 (0.95, 1.23)Medical History of DM
8959 11.7 11.9 0.99 (0.88, 1.13)
0.2
P value(Interaction)
0.68
0.77
0.42
1.00
0.76
0.12
0.35
0.75
1752 12.9 12.2 1.06 (0.80, 1.40)13747 11.1 11.0 1.01 (0.91, 1.13)
0.21
HRs and cumulative incidence of major bleeding (pre-defined subgroups - cont’d)
Wallentin L, et al.New Engl J Med. 2009;361.15
Ticagrelor better Clopidogrel better
Ti. Cl.Total
Patients
KM % atMonth 12
HR (95% CI)Hazard Ratio
(95% CI)
Yes
Yes
Revascularization History of CABG
Sex
Weight Group
≥65 Years
Characteristic
0.5 1.0 2.0
17086 11.5 10.9 1.06 (0.96, 1.16)<80 kg
1296 12.6 15.2 0.82 (0.60, 1.12)≥60 kg
5237 10.7 10.5 1.01 (0.85, 1.21)
<60 kg
13184 11.9 11.4 1.05 (0.94, 1.16)Female
2846 14.2 13.3 1.04 (0.84, 1.29)
Male
15574 11.1 10.8 1.04 (0.94, 1.15)≥75 Years
7892 14.4 13.6 1.07 (0.95, 1.22)<75 Years
10528 9.5 9.5 1.00 (0.87, 1.13)<65 Years
1136 14.6 14.9 0.99 (0.71, 1.37)Age Group
17284 11.4 11.0 1.04 (0.95, 1.14)No
1092 7.3 7.8 0.94 (0.60, 1.49)Previous TIA/Non-hemorrhagic Stroke
17329 11.8 11.4 1.04 (0.95, 1.14)No
Yes
Central/South America
≥80 kg
North America
1230 15.6 13.2 1.22 (0.89, 1.66)Europe/Middle East/Africa
1692 10.6 10.8 1.03 (0.76, 1.40)Asia/Australia
4621 14.1 14.8 0.95 (0.81, 1.12)Region
13800 10.8 10.0 1.08 (0.97, 1.20)No
9423 11.4 10.5 1.08 (0.95, 1.23)Medical History of DM
8959 11.7 11.9 0.99 (0.88, 1.13)
0.2
P value(Interaction)
0.68
0.77
0.42
1.00
0.76
0.12
0.35
0.75
1752 12.9 12.2 1.06 (0.80, 1.40)13747 11.1 11.0 1.01 (0.91, 1.13)
0.21
HRs and cumulative incidence of major bleeding (pre-defined subgroups - cont’d)
Wallentin L, et al.New Engl J Med. 2009;361.15
Ticagrelor better Clopidogrel better
Ti. Cl.Total
Patients
KM % atMonth 12
HR (95% CI)Hazard Ratio
(95% CI)
Yes
Yes
Revascularization History of CABG
Sex
Weight Group
≥65 Years
Characteristic
0.5 1.0 2.0
17086 11.5 10.9 1.06 (0.96, 1.16)<80 kg
1296 12.6 15.2 0.82 (0.60, 1.12)≥60 kg
5237 10.7 10.5 1.01 (0.85, 1.21)
<60 kg
13184 11.9 11.4 1.05 (0.94, 1.16)Female
2846 14.2 13.3 1.04 (0.84, 1.29)
Male
15574 11.1 10.8 1.04 (0.94, 1.15)≥75 Years
7892 14.4 13.6 1.07 (0.95, 1.22)<75 Years
10528 9.5 9.5 1.00 (0.87, 1.13)<65 Years
1136 14.6 14.9 0.99 (0.71, 1.37)Age Group
17284 11.4 11.0 1.04 (0.95, 1.14)No
1092 7.3 7.8 0.94 (0.60, 1.49)Previous TIA/Non-hemorrhagic Stroke
17329 11.8 11.4 1.04 (0.95, 1.14)No
Yes
Central/South America
≥80 kg
North America
1230 15.6 13.2 1.22 (0.89, 1.66)Europe/Middle East/Africa
1692 10.6 10.8 1.03 (0.76, 1.40)Asia/Australia
4621 14.1 14.8 0.95 (0.81, 1.12)Region
13800 10.8 10.0 1.08 (0.97, 1.20)No
9423 11.4 10.5 1.08 (0.95, 1.23)Medical History of DM
8959 11.7 11.9 0.99 (0.88, 1.13)
0.2
P value(Interaction)
0.68
0.77
0.42
1.00
0.76
0.12
0.35
0.75
1752 12.9 12.2 1.06 (0.80, 1.40)13747 11.1 11.0 1.01 (0.91, 1.13)
0.21
HRs and cumulative incidence of major bleeding (pre-defined subgroups - cont’d)
Wallentin L, et al.New Engl J Med. 2009;361.15
Ticagrelor better Clopidogrel better
Ti. Cl.Total
Patients
KM % atMonth 12
HR (95% CI)Hazard Ratio
(95% CI)
Yes
Yes
Revascularization History of CABG
Sex
Weight Group
≥65 Years
Characteristic
0.5 1.0 2.0
17256 9.5 11.2 0.86 (0.78, 0.94)<80 kg
1312 13.1 17.3 0.75 (0.60, 0.99)≥60 kg
5288 11.2 13.2 0.83 (0.71, 0.97)
<60 kg
13336 9.2 11.1 0.85 (0.76, 0.95)Female
2878 16.8 18.3 0.94 (0.78, 1.12)
Male
15744 8.6 10.4 0.82 (0.74, 0.91)≥75 Years
7979 13.2 16.0 0.83 (0.74, 0.94)<75 Years
10643 7.2 8.5 0.85 (0.74, 0.97)<65 Years
1152 19.0 20.8 0.87 (0.66, 1.13)Age Group
17462 9.2 11.1 0.84 (0.76, 0.93)No
1106 19.5 21.7 0.88 (0.67, 1.15)Previous TIA/Non-hemorrhagic Stroke
17518 9.2 11.0 0.84 (0.77, 0.93)No
Yes
Central/South America
≥80 kg
North America
1237 15.2 17.9 0.86 (0.65, 1.13)Europe/Middle East/Africa
1714 11.4 14.8 0.80 (0.61, 1.04)Asia/Australia
4662 14.1 16.2 0.88 (0.76, 1.03)Region
13962 8.4 10.2 0.83 (0.74, 0.92)No
9513 8.3 10.5 0.79 (0.69, 0.90)Medical History of DM
9055 11.4 12.8 0.90 (0.79, 1.01)
0.2
p- value(Interaction)
0.76
0.84
0.86
0.22
0.82
0.36
0.17
0.05
1814 11.9 9.6 1.25 (0.93, 1.67)13859 8.8 11.0 0.80 (0.72, 0.90)
0.49
Primary Endpoint in Pre-defined Subgroups (Cont’d)
Wallentin L, et al.New Engl J Med. 2009;361.
14
Ticagrelor better Clopidogrel better
Ti. Cl.Total
Patients
KM % atMonth 12
HR (95% CI)Hazard Ratio
(95% CI)
Yes
Yes
Revascularization History of CABG
Sex
Weight Group
≥65 Years
Characteristic
0.5 1.0 2.0
17256 9.5 11.2 0.86 (0.78, 0.94)<80 kg
1312 13.1 17.3 0.75 (0.60, 0.99)≥60 kg
5288 11.2 13.2 0.83 (0.71, 0.97)
<60 kg
13336 9.2 11.1 0.85 (0.76, 0.95)Female
2878 16.8 18.3 0.94 (0.78, 1.12)
Male
15744 8.6 10.4 0.82 (0.74, 0.91)≥75 Years
7979 13.2 16.0 0.83 (0.74, 0.94)<75 Years
10643 7.2 8.5 0.85 (0.74, 0.97)<65 Years
1152 19.0 20.8 0.87 (0.66, 1.13)Age Group
17462 9.2 11.1 0.84 (0.76, 0.93)No
1106 19.5 21.7 0.88 (0.67, 1.15)Previous TIA/Non-hemorrhagic Stroke
17518 9.2 11.0 0.84 (0.77, 0.93)No
Yes
Central/South America
≥80 kg
North America
1237 15.2 17.9 0.86 (0.65, 1.13)Europe/Middle East/Africa
1714 11.4 14.8 0.80 (0.61, 1.04)Asia/Australia
4662 14.1 16.2 0.88 (0.76, 1.03)Region
13962 8.4 10.2 0.83 (0.74, 0.92)No
9513 8.3 10.5 0.79 (0.69, 0.90)Medical History of DM
9055 11.4 12.8 0.90 (0.79, 1.01)
0.2
p- value(Interaction)
0.76
0.84
0.86
0.22
0.82
0.36
0.17
0.05
1814 11.9 9.6 1.25 (0.93, 1.67)13859 8.8 11.0 0.80 (0.72, 0.90)
0.49
Primary Endpoint in Pre-defined Subgroups (Cont’d)
Wallentin L, et al.New Engl J Med. 2009;361.
14
Ticagrelor better Clopidogrel better
Ti. Cl.Total
Patients
KM % atMonth 12
HR (95% CI)Hazard Ratio
(95% CI)
Yes
Yes
Revascularization History of CABG
Sex
Weight Group
≥65 Years
Characteristic
0.5 1.0 2.0
17256 9.5 11.2 0.86 (0.78, 0.94)<80 kg
1312 13.1 17.3 0.75 (0.60, 0.99)≥60 kg
5288 11.2 13.2 0.83 (0.71, 0.97)
<60 kg
13336 9.2 11.1 0.85 (0.76, 0.95)Female
2878 16.8 18.3 0.94 (0.78, 1.12)
Male
15744 8.6 10.4 0.82 (0.74, 0.91)≥75 Years
7979 13.2 16.0 0.83 (0.74, 0.94)<75 Years
10643 7.2 8.5 0.85 (0.74, 0.97)<65 Years
1152 19.0 20.8 0.87 (0.66, 1.13)Age Group
17462 9.2 11.1 0.84 (0.76, 0.93)No
1106 19.5 21.7 0.88 (0.67, 1.15)Previous TIA/Non-hemorrhagic Stroke
17518 9.2 11.0 0.84 (0.77, 0.93)No
Yes
Central/South America
≥80 kg
North America
1237 15.2 17.9 0.86 (0.65, 1.13)Europe/Middle East/Africa
1714 11.4 14.8 0.80 (0.61, 1.04)Asia/Australia
4662 14.1 16.2 0.88 (0.76, 1.03)Region
13962 8.4 10.2 0.83 (0.74, 0.92)No
9513 8.3 10.5 0.79 (0.69, 0.90)Medical History of DM
9055 11.4 12.8 0.90 (0.79, 1.01)
0.2
p- value(Interaction)
0.76
0.84
0.86
0.22
0.82
0.36
0.17
0.05
1814 11.9 9.6 1.25 (0.93, 1.67)13859 8.8 11.0 0.80 (0.72, 0.90)
0.49
Primary Endpoint in Pre-defined Subgroups (Cont’d)
Wallentin L, et al.New Engl J Med. 2009;361.
14
Ticagrelor better Clopidogrel better
Ti. Cl.Total
Patients
KM % atMonth 12
HR (95% CI)Hazard Ratio
(95% CI)
Yes
Yes
Revascularization History of CABG
Sex
Weight Group
≥65 Years
Characteristic
0.5 1.0 2.0
17256 9.5 11.2 0.86 (0.78, 0.94)<80 kg
1312 13.1 17.3 0.75 (0.60, 0.99)≥60 kg
5288 11.2 13.2 0.83 (0.71, 0.97)
<60 kg
13336 9.2 11.1 0.85 (0.76, 0.95)Female
2878 16.8 18.3 0.94 (0.78, 1.12)
Male
15744 8.6 10.4 0.82 (0.74, 0.91)≥75 Years
7979 13.2 16.0 0.83 (0.74, 0.94)<75 Years
10643 7.2 8.5 0.85 (0.74, 0.97)<65 Years
1152 19.0 20.8 0.87 (0.66, 1.13)Age Group
17462 9.2 11.1 0.84 (0.76, 0.93)No
1106 19.5 21.7 0.88 (0.67, 1.15)Previous TIA/Non-hemorrhagic Stroke
17518 9.2 11.0 0.84 (0.77, 0.93)No
Yes
Central/South America
≥80 kg
North America
1237 15.2 17.9 0.86 (0.65, 1.13)Europe/Middle East/Africa
1714 11.4 14.8 0.80 (0.61, 1.04)Asia/Australia
4662 14.1 16.2 0.88 (0.76, 1.03)Region
13962 8.4 10.2 0.83 (0.74, 0.92)No
9513 8.3 10.5 0.79 (0.69, 0.90)Medical History of DM
9055 11.4 12.8 0.90 (0.79, 1.01)
0.2
p- value(Interaction)
0.76
0.84
0.86
0.22
0.82
0.36
0.17
0.05
1814 11.9 9.6 1.25 (0.93, 1.67)13859 8.8 11.0 0.80 (0.72, 0.90)
0.49
Primary Endpoint in Pre-defined Subgroups (Cont’d)
Wallentin L, et al.New Engl J Med. 2009;361.
14
Ticagrelor better Clopidogrel better
Ti. Cl.Total
Patients
KM % atMonth 12
HR (95% CI)Hazard Ratio
(95% CI)
Yes
Yes
Revascularization History of CABG
Sex
Weight Group
≥65 Years
Characteristic
0.5 1.0 2.0
17256 9.5 11.2 0.86 (0.78, 0.94)<80 kg
1312 13.1 17.3 0.75 (0.60, 0.99)≥60 kg
5288 11.2 13.2 0.83 (0.71, 0.97)
<60 kg
13336 9.2 11.1 0.85 (0.76, 0.95)Female
2878 16.8 18.3 0.94 (0.78, 1.12)
Male
15744 8.6 10.4 0.82 (0.74, 0.91)≥75 Years
7979 13.2 16.0 0.83 (0.74, 0.94)<75 Years
10643 7.2 8.5 0.85 (0.74, 0.97)<65 Years
1152 19.0 20.8 0.87 (0.66, 1.13)Age Group
17462 9.2 11.1 0.84 (0.76, 0.93)No
1106 19.5 21.7 0.88 (0.67, 1.15)Previous TIA/Non-hemorrhagic Stroke
17518 9.2 11.0 0.84 (0.77, 0.93)No
Yes
Central/South America
≥80 kg
North America
1237 15.2 17.9 0.86 (0.65, 1.13)Europe/Middle East/Africa
1714 11.4 14.8 0.80 (0.61, 1.04)Asia/Australia
4662 14.1 16.2 0.88 (0.76, 1.03)Region
13962 8.4 10.2 0.83 (0.74, 0.92)No
9513 8.3 10.5 0.79 (0.69, 0.90)Medical History of DM
9055 11.4 12.8 0.90 (0.79, 1.01)
0.2
p- value(Interaction)
0.76
0.84
0.86
0.22
0.82
0.36
0.17
0.05
1814 11.9 9.6 1.25 (0.93, 1.67)13859 8.8 11.0 0.80 (0.72, 0.90)
0.49
Primary Endpoint in Pre-defined Subgroups (Cont’d)
Wallentin L, et al.New Engl J Med. 2009;361.
14
Ticagrelor better Clopidogrel better
Ti. Cl.Total
Patients
KM % atMonth 12
HR (95% CI)Hazard Ratio
(95% CI)
Yes
Yes
Revascularization History of CABG
Sex
Weight Group
≥65 Years
Characteristic
0.5 1.0 2.0
17256 9.5 11.2 0.86 (0.78, 0.94)<80 kg
1312 13.1 17.3 0.75 (0.60, 0.99)≥60 kg
5288 11.2 13.2 0.83 (0.71, 0.97)
<60 kg
13336 9.2 11.1 0.85 (0.76, 0.95)Female
2878 16.8 18.3 0.94 (0.78, 1.12)
Male
15744 8.6 10.4 0.82 (0.74, 0.91)≥75 Years
7979 13.2 16.0 0.83 (0.74, 0.94)<75 Years
10643 7.2 8.5 0.85 (0.74, 0.97)<65 Years
1152 19.0 20.8 0.87 (0.66, 1.13)Age Group
17462 9.2 11.1 0.84 (0.76, 0.93)No
1106 19.5 21.7 0.88 (0.67, 1.15)Previous TIA/Non-hemorrhagic Stroke
17518 9.2 11.0 0.84 (0.77, 0.93)No
Yes
Central/South America
≥80 kg
North America
1237 15.2 17.9 0.86 (0.65, 1.13)Europe/Middle East/Africa
1714 11.4 14.8 0.80 (0.61, 1.04)Asia/Australia
4662 14.1 16.2 0.88 (0.76, 1.03)Region
13962 8.4 10.2 0.83 (0.74, 0.92)No
9513 8.3 10.5 0.79 (0.69, 0.90)Medical History of DM
9055 11.4 12.8 0.90 (0.79, 1.01)
0.2
p- value(Interaction)
0.76
0.84
0.86
0.22
0.82
0.36
0.17
0.05
1814 11.9 9.6 1.25 (0.93, 1.67)13859 8.8 11.0 0.80 (0.72, 0.90)
0.49
Primary Endpoint in Pre-defined Subgroups (Cont’d)
Wallentin L, et al.New Engl J Med. 2009;361.
14
Ticagrelor better Clopidogrel better
Ti. Cl.Total
Patients
KM % atMonth 12
HR (95% CI)Hazard Ratio
(95% CI)
Yes
Yes
Revascularization History of CABG
Sex
Weight Group
≥65 Years
Characteristic
0.5 1.0 2.0
17256 9.5 11.2 0.86 (0.78, 0.94)<80 kg
1312 13.1 17.3 0.75 (0.60, 0.99)≥60 kg
5288 11.2 13.2 0.83 (0.71, 0.97)
<60 kg
13336 9.2 11.1 0.85 (0.76, 0.95)Female
2878 16.8 18.3 0.94 (0.78, 1.12)
Male
15744 8.6 10.4 0.82 (0.74, 0.91)≥75 Years
7979 13.2 16.0 0.83 (0.74, 0.94)<75 Years
10643 7.2 8.5 0.85 (0.74, 0.97)<65 Years
1152 19.0 20.8 0.87 (0.66, 1.13)Age Group
17462 9.2 11.1 0.84 (0.76, 0.93)No
1106 19.5 21.7 0.88 (0.67, 1.15)Previous TIA/Non-hemorrhagic Stroke
17518 9.2 11.0 0.84 (0.77, 0.93)No
Yes
Central/South America
≥80 kg
North America
1237 15.2 17.9 0.86 (0.65, 1.13)Europe/Middle East/Africa
1714 11.4 14.8 0.80 (0.61, 1.04)Asia/Australia
4662 14.1 16.2 0.88 (0.76, 1.03)Region
13962 8.4 10.2 0.83 (0.74, 0.92)No
9513 8.3 10.5 0.79 (0.69, 0.90)Medical History of DM
9055 11.4 12.8 0.90 (0.79, 1.01)
0.2
p- value(Interaction)
0.76
0.84
0.86
0.22
0.82
0.36
0.17
0.05
1814 11.9 9.6 1.25 (0.93, 1.67)13859 8.8 11.0 0.80 (0.72, 0.90)
0.49
Primary Endpoint in Pre-defined Subgroups (Cont’d)
Wallentin L, et al.New Engl J Med. 2009;361.
14
Ticagrelor better Clopidogrel better
Ti. Cl.Total
Patients
KM % atMonth 12
HR (95% CI)Hazard Ratio
(95% CI)
Yes
Yes
Revascularization History of CABG
Sex
Weight Group
≥65 Years
Characteristic
0.5 1.0 2.0
17256 9.5 11.2 0.86 (0.78, 0.94)<80 kg
1312 13.1 17.3 0.75 (0.60, 0.99)≥60 kg
5288 11.2 13.2 0.83 (0.71, 0.97)
<60 kg
13336 9.2 11.1 0.85 (0.76, 0.95)Female
2878 16.8 18.3 0.94 (0.78, 1.12)
Male
15744 8.6 10.4 0.82 (0.74, 0.91)≥75 Years
7979 13.2 16.0 0.83 (0.74, 0.94)<75 Years
10643 7.2 8.5 0.85 (0.74, 0.97)<65 Years
1152 19.0 20.8 0.87 (0.66, 1.13)Age Group
17462 9.2 11.1 0.84 (0.76, 0.93)No
1106 19.5 21.7 0.88 (0.67, 1.15)Previous TIA/Non-hemorrhagic Stroke
17518 9.2 11.0 0.84 (0.77, 0.93)No
Yes
Central/South America
≥80 kg
North America
1237 15.2 17.9 0.86 (0.65, 1.13)Europe/Middle East/Africa
1714 11.4 14.8 0.80 (0.61, 1.04)Asia/Australia
4662 14.1 16.2 0.88 (0.76, 1.03)Region
13962 8.4 10.2 0.83 (0.74, 0.92)No
9513 8.3 10.5 0.79 (0.69, 0.90)Medical History of DM
9055 11.4 12.8 0.90 (0.79, 1.01)
0.2
p- value(Interaction)
0.76
0.84
0.86
0.22
0.82
0.36
0.17
0.05
1814 11.9 9.6 1.25 (0.93, 1.67)13859 8.8 11.0 0.80 (0.72, 0.90)
0.49
Primary Endpoint in Pre-defined Subgroups (Cont’d)
Wallentin L, et al.New Engl J Med. 2009;361.
14
Ticagrelor better Clopidogrel better
Ti. Cl.Total
Patients
KM % atMonth 12
HR (95% CI)Hazard Ratio
(95% CI)
Yes
Yes
Revascularization History of CABG
Sex
Weight Group
≥65 Years
Characteristic
0.5 1.0 2.0
17256 9.5 11.2 0.86 (0.78, 0.94)<80 kg
1312 13.1 17.3 0.75 (0.60, 0.99)≥60 kg
5288 11.2 13.2 0.83 (0.71, 0.97)
<60 kg
13336 9.2 11.1 0.85 (0.76, 0.95)Female
2878 16.8 18.3 0.94 (0.78, 1.12)
Male
15744 8.6 10.4 0.82 (0.74, 0.91)≥75 Years
7979 13.2 16.0 0.83 (0.74, 0.94)<75 Years
10643 7.2 8.5 0.85 (0.74, 0.97)<65 Years
1152 19.0 20.8 0.87 (0.66, 1.13)Age Group
17462 9.2 11.1 0.84 (0.76, 0.93)No
1106 19.5 21.7 0.88 (0.67, 1.15)Previous TIA/Non-hemorrhagic Stroke
17518 9.2 11.0 0.84 (0.77, 0.93)No
Yes
Central/South America
≥80 kg
North America
1237 15.2 17.9 0.86 (0.65, 1.13)Europe/Middle East/Africa
1714 11.4 14.8 0.80 (0.61, 1.04)Asia/Australia
4662 14.1 16.2 0.88 (0.76, 1.03)Region
13962 8.4 10.2 0.83 (0.74, 0.92)No
9513 8.3 10.5 0.79 (0.69, 0.90)Medical History of DM
9055 11.4 12.8 0.90 (0.79, 1.01)
0.2
p- value(Interaction)
0.76
0.84
0.86
0.22
0.82
0.36
0.17
0.05
1814 11.9 9.6 1.25 (0.93, 1.67)13859 8.8 11.0 0.80 (0.72, 0.90)
0.49
Primary Endpoint in Pre-defined Subgroups (Cont’d)
Wallentin L, et al.New Engl J Med. 2009;361.
14
Ticagrelor better Clopidogrel better
Ti. Cl.Total
Patients
KM % atMonth 12
HR (95% CI)Hazard Ratio
(95% CI)
Yes
Yes
Revascularization History of CABG
Sex
Weight Group
≥65 Years
Characteristic
0.5 1.0 2.0
17256 9.5 11.2 0.86 (0.78, 0.94)<80 kg
1312 13.1 17.3 0.75 (0.60, 0.99)≥60 kg
5288 11.2 13.2 0.83 (0.71, 0.97)
<60 kg
13336 9.2 11.1 0.85 (0.76, 0.95)Female
2878 16.8 18.3 0.94 (0.78, 1.12)
Male
15744 8.6 10.4 0.82 (0.74, 0.91)≥75 Years
7979 13.2 16.0 0.83 (0.74, 0.94)<75 Years
10643 7.2 8.5 0.85 (0.74, 0.97)<65 Years
1152 19.0 20.8 0.87 (0.66, 1.13)Age Group
17462 9.2 11.1 0.84 (0.76, 0.93)No
1106 19.5 21.7 0.88 (0.67, 1.15)Previous TIA/Non-hemorrhagic Stroke
17518 9.2 11.0 0.84 (0.77, 0.93)No
Yes
Central/South America
≥80 kg
North America
1237 15.2 17.9 0.86 (0.65, 1.13)Europe/Middle East/Africa
1714 11.4 14.8 0.80 (0.61, 1.04)Asia/Australia
4662 14.1 16.2 0.88 (0.76, 1.03)Region
13962 8.4 10.2 0.83 (0.74, 0.92)No
9513 8.3 10.5 0.79 (0.69, 0.90)Medical History of DM
9055 11.4 12.8 0.90 (0.79, 1.01)
0.2
p- value(Interaction)
0.76
0.84
0.86
0.22
0.82
0.36
0.17
0.05
1814 11.9 9.6 1.25 (0.93, 1.67)13859 8.8 11.0 0.80 (0.72, 0.90)
0.49
Primary Endpoint in Pre-defined Subgroups (Cont’d)
Wallentin L, et al.New Engl J Med. 2009;361.
14
1° efficacy endpoint1° efficacy endpoint 1° safety endpoint1° safety endpoint
Previous non-hemorh. CVANoYes
Age Group< 75 years> 75 years
Weight group< 60 kg> 60 kg
Previous non-hemorh. CVANoYes
Age Group< 75 years> 75 years
Weight group< 60 kg> 60 kg
ticagrelor betterticagrelor betterclopidogrel betterclopidogrel better ticagrelor betterticagrelor betterclopidogrel betterclopidogrel better
No contraindication for ticagrelor with previous stroke
Wallentin L et al., N Engl J Med 2009
PLATOPLATO
![Page 5: ¿Cuáles son las limitaciones de los nuevos antiagregantes?](https://reader036.vdocuments.co/reader036/viewer/2022062309/5665b47c1a28abb57c91e715/html5/thumbnails/5.jpg)
Estimated Event Rate (CV Death / MI / Stroke) at 1 Y ear
0.00
0.05
0.10
0.15
0.20
0.25
0.30
0.35
25 35 45 55 65 75 85 95
Age (years)
Ev
en
t R
ate
Ticagrelor ClopidogrelOne Model - Interaction
Age and primary efficacy outomes in PLATO
Husted et al 2011, ACC
![Page 6: ¿Cuáles son las limitaciones de los nuevos antiagregantes?](https://reader036.vdocuments.co/reader036/viewer/2022062309/5665b47c1a28abb57c91e715/html5/thumbnails/6.jpg)
6
PLATO: total mortality according to PLATO: total mortality according to prior history of stroke/TIAprior history of stroke/TIA
James S, et al. Circulation 2012;125:2914–2921.
%
![Page 7: ¿Cuáles son las limitaciones de los nuevos antiagregantes?](https://reader036.vdocuments.co/reader036/viewer/2022062309/5665b47c1a28abb57c91e715/html5/thumbnails/7.jpg)
European NSTE ACS SummitSeptember 18th / 19th 2013 Brussels
![Page 8: ¿Cuáles son las limitaciones de los nuevos antiagregantes?](https://reader036.vdocuments.co/reader036/viewer/2022062309/5665b47c1a28abb57c91e715/html5/thumbnails/8.jpg)
European NSTE ACS SummitSeptember 18th / 19th 2013 Brussels
![Page 9: ¿Cuáles son las limitaciones de los nuevos antiagregantes?](https://reader036.vdocuments.co/reader036/viewer/2022062309/5665b47c1a28abb57c91e715/html5/thumbnails/9.jpg)
European NSTE ACS SummitSeptember 18th / 19th 2013 Brussels
![Page 10: ¿Cuáles son las limitaciones de los nuevos antiagregantes?](https://reader036.vdocuments.co/reader036/viewer/2022062309/5665b47c1a28abb57c91e715/html5/thumbnails/10.jpg)
European NSTE ACS SummitSeptember 18th / 19th 2013 Brussels
![Page 11: ¿Cuáles son las limitaciones de los nuevos antiagregantes?](https://reader036.vdocuments.co/reader036/viewer/2022062309/5665b47c1a28abb57c91e715/html5/thumbnails/11.jpg)
¿a quién no debo administrar prasugrel?
¿a quién no de administrar ticagrelor?
¿a quién no debo administrar clopidogrel?
¿Cuánto debo esperar para operar tras suspender el tratamiento?
Nuevos antiagregantes ¿a quién?: preguntas