Article Impact Level: HIGH Data Quality: STRONG Summary of New England Journal of Medicine, 385(27), 2520–2530. https://doi.org/10.1056/NEJMoa2111749 Dr. Yongjun Wang et al
Points
- The CHANCE-2 study found that the chance of cerebral infarction incident during three months was lesser with ticagrelor compared to clopidogrel within Chinese sufferers with a transient thrombotic stroke who were holders of CYP2C19 loss-of-function genes.
- The initial testing offers compelling support for the administration of ticagrelor compared to clopidogrel in sick people with loss-of-function carrier category, but the representativeness of this experiment is severely constrained by the expense and accessibility of quick genetic analysis as well as the predominance of Han Chinese patients.
- Many individuals may still have concerns about the recognized side effects of ticagrelor, including hemorrhage and breathlessness.
Summary
The investigation’s objective was to compare the effectiveness of ticagrelor plus aspirin vs. clopidogrel and aspirin in decreasing the risk of future stroke who had already experienced a stroke or an elevated transient ischemic attack and were CYP2C19 loss-of-function bearers.
During 24 hours after the symptoms began, individuals with a history of stroke, transient ischemic attack, or CYP2C19 loss-of-function mutations were randomly assigned to administer ticagrelor-aspirin or clopidogrel-aspirin. In contrast to clopidogrel, which had a 300 mg initial dosage, ticagrelor was given at a dose of 90 mg two times a day. 75–300 mg of aspirin was taken as an induction therapy before being taken every day for three weeks. Individuals were cured and monitored for a further 9 months after three months at the regional investigator’s choice.
Individuals above 40 years were selected as the participants of the trial. Moreover, those with disabling stroke and severe transient ischemic attacks of grade 4 or above were included in the testing. Individuals with mechanical thrombectomy, mild to severe disability, and those currently who received anticoagulation therapy were excluded from the experiment.
When ticagrelor and aspirin were compared to clopidogrel and aspirin, the main result about new ischemic or hemorrhagic stroke after three months was 6.0% vs. 7.6%, respectively.
According to the experiment’s findings, individuals who were CYP2C19 loss-of-function gene holders had a decreased risk of a heart attack at three months when using ticagrelor and aspirin than when taking clopidogrel and aspirin. Compared to clopidogrel-aspirin, ticagrelor-aspirin was more beneficial for those with regular kidney functioning.
While the incidence of average hemorrhage and side effects, including breathlessness, was greater with ticagrelor, there weren’t any elevations in mild or severe bleeding. A genotype-guided approach to selecting antiplatelet medication in sufferers with acute coronary syndrome showed conflicting findings, with further studies demonstrating no advantage in reducing significant adverse cardiovascular events.
Link to the article: https://www.nejm.org/doi/full/10.1056/NEJMoa2111749
References Wang, Y., Meng, X., Wang, A., Xie, X., Pan, Y., Johnston, S. C., Li, H., Bath, P. M., Dong, Q., Xu, A., Jing, J., Lin, J., Niu, S., Wang, Y., Zhao, X., Li, Z., Jiang, Y., Li, W., Liu, L., … Wang, B. (2021). Ticagrelor versus clopidogrel in cyp2c19 loss-of-function carriers with stroke or tia. New England Journal of Medicine, 385(27), 2520–2530. https://doi.org/10.1056/NEJMoa2111749
