JACC. Asia · 2025
Bleeding Outcomes of Ticagrelor Versus Clopidogrel in Acute Coronary Syndrome Patients: A Multiethnic Database Study.
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Loh Guek Leng, Chong Kok Joon, Ganesan Ganga, Chan Mark Yan Yee, Tan Jack Wei Chieh, Chin Chee Tang, Ho Hee Hwa, Imran Syed Saqib, Tan Doreen Su-Yin
Аннотация
BACKGROUND: Compared with Caucasians, East Asians with acute coronary syndrome (ACS) respond differently to P2Y12 inhibitors.
OBJECTIVES: The purpose of this study was to compare bleeding outcomes between ticagrelor and clopidogrel, and identify bleeding predictors in a multiethnic South-East Asian ACS cohort.
METHODS: We conducted a retrospective, propensity-matched, nationwide database cohort study of ACS patients who underwent coronary revascularization in Singapore, and compared 1-year bleeding outcomes of ticagrelor and clopidogrel. Independent bleeding predictors were investigated using multivariate logistic regression analysis.
RESULTS: Between January 2013 and December 2017, 14,812 ACS patients (8,502 [57%] clopidogrel and 6,310 [43%] ticagrelor) were eligible for the study. Median follow-up was 12 months (Q1-Q3: 12-12 months). Ticagrelor was associated with higher risk of any clinically relevant bleeding (adjusted HR: 1.20; 95% CI: 1.02-1.40; P = 0.022), particularly Bleeding Academic Research Consortium (BARC) type 3 bleeding (adjusted HR: 1.33; 95% CI: 1.04-1.69; P = 0.023), compared with clopidogrel. Independent bleeding predictors were ticagrelor use, age ≥65 years, increasing comorbidities, chronic obstructive pulmonary disease, hyperlipidemia, severe chronic kidney disease, anemia, prior bleeding within 6 months, and concurrent oral anticoagulant use. Indians and "others" experienced lower bleeding odds than Chinese, while Malays and Chinese had similar odds.
CONCLUSIONS: Ticagrelor was associated with increased risk of BARC type 3 bleeding compared with clopidogrel. Novel risk factors Indian and "other" ethnicity appeared protective, while age ≥65 years, increasing comorbidities, chronic obstructive pulmonary disease, and hyperlipidemia were associated with increased bleeding odds. These novel bleeding risk factors warrant validation in a prospective study.
OBJECTIVES: The purpose of this study was to compare bleeding outcomes between ticagrelor and clopidogrel, and identify bleeding predictors in a multiethnic South-East Asian ACS cohort.
METHODS: We conducted a retrospective, propensity-matched, nationwide database cohort study of ACS patients who underwent coronary revascularization in Singapore, and compared 1-year bleeding outcomes of ticagrelor and clopidogrel. Independent bleeding predictors were investigated using multivariate logistic regression analysis.
RESULTS: Between January 2013 and December 2017, 14,812 ACS patients (8,502 [57%] clopidogrel and 6,310 [43%] ticagrelor) were eligible for the study. Median follow-up was 12 months (Q1-Q3: 12-12 months). Ticagrelor was associated with higher risk of any clinically relevant bleeding (adjusted HR: 1.20; 95% CI: 1.02-1.40; P = 0.022), particularly Bleeding Academic Research Consortium (BARC) type 3 bleeding (adjusted HR: 1.33; 95% CI: 1.04-1.69; P = 0.023), compared with clopidogrel. Independent bleeding predictors were ticagrelor use, age ≥65 years, increasing comorbidities, chronic obstructive pulmonary disease, hyperlipidemia, severe chronic kidney disease, anemia, prior bleeding within 6 months, and concurrent oral anticoagulant use. Indians and "others" experienced lower bleeding odds than Chinese, while Malays and Chinese had similar odds.
CONCLUSIONS: Ticagrelor was associated with increased risk of BARC type 3 bleeding compared with clopidogrel. Novel risk factors Indian and "other" ethnicity appeared protective, while age ≥65 years, increasing comorbidities, chronic obstructive pulmonary disease, and hyperlipidemia were associated with increased bleeding odds. These novel bleeding risk factors warrant validation in a prospective study.