ISSN: 1885-5857 Impact factor 2023 7.2
Vol. 77. Num. 4.
Pages 356 (April 2024)

Letter to the editor
Risk of ticagrelor versus clopidogrel discontinuation

Riesgo de interrupción del ticagrelor frente al clopidogrel

Manuel Martínez-Sellésab
Rev Esp Cardiol. 2024;77:113-2410.1016/j.rec.2023.05.011
Manuel Almendro-Delia, Gloria Padilla-Rodríguez, Begoña Hernández-Meneses, Emilia Blanco-Ponce, José A. Arboleda-Sánchez, Juan Carlos Rodríguez-Yáñez, José Manuel Soto-Blanco, Isabel Fernández-García, José M. Castillo-Caballero, Juan C. García-Rubira, Rafael Hidalgo-Urbano
Rev Esp Cardiol. 2024;77:356-710.1016/j.rec.2023.11.015
Manuel Almendro-Delia, Juan C. García-Rubira, Rafael Hidalgo-Urbano
To the Editor,

In their recent article, Almendro-Delia et al.1 concluded that the association between nonadherence to ticagrelor vs clopidogrel and the risk of major adverse cardiac events (MACE) was not modulated by the choice of P2Y12 receptor inhibitor. Nonetheless, 60 of the 1078 patients on ticagrelor (5.5%) stopped using this drug, while almost twice as many (114/1102 patients, 10.4%) stopped using clopidogrel. In the analysis of factors associated with premature cessation of dual antiplatelet therapy (DAPT), ticagrelor (vs clopidogrel) had an adjusted hazard ratio of 0.97 (95%CI, 0.93-1.01) and a P value of .080, suggesting that the association between nonadherence to DAPT and MACE can in fact be modulated by choice of inhibitor. That said, previous studies have shown an increased risk of bleeding with ticagrelor compared with clopidogrel,2–4 whereas the data presented by Almendro-Delia et al.1 seem to suggest that patients on clopidogrel have a lower risk of DAPT cessation than those on ticagrelor. These findings warrant further discussion and clarification.

FUNDING

No funding.

STATEMENT ON THE USE OF ARTIFICIAL INTELLIGENCE

Artificial intelligence was not used for this work.

CONFLICTS OF INTEREST

None.

References
[1]
M. Almendro-Delia, G. Padilla-Rodríguez, B. Hernández-Meneses, et al.
Nonadherence to ticagrelor versus clopidogrel and clinical outcomes in patients with ACS. Results from the CREA-ARIAM registry.
[2]
E.P. Navarese, S.U. Khan, M. Kołodziejczak, et al.
Comparative Efficacy and Safety of Oral P2Y12 Inhibitors in Acute Coronary Syndrome: Network Meta-Analysis of 52 816 Patients From 12 Randomized Trials.
Circulation., (2020), 142 pp. 150-160
[3]
M. Gimbel, K. Qaderdan, L. Willemsen, et al.
Clopidogrel versus ticagrelor or prasugrel in patients aged 70 years or older with non-ST-elevation acute coronary syndrome (POPular AGE): the randomised, open-label, non-inferiority trial.
Lancet., (2020), 395 pp. 1374-1381
[4]
L. Mullen, M.N. Meah, A. Elamin, et al.
Risk of Major Bleeding With Potent Antiplatelet Agents After an Acute Coronary Event: A Comparison of Ticagrelor and Clopidogrel in 5116 Consecutive Patients in Clinical Practice.
J Am Heart Assoc., (2021), 10 pp. e019467
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