Division of Cardiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina.
Division of Cardiology, University of Texas Southwestern School of Medicine, Dallas, Texas.
J Am Coll Cardiol. 2019 May 21;73(19):2454-2464. doi: 10.1016/j.jacc.2019.03.470.
Ticagrelor is a cornerstone of modern antithrombotic therapy alongside aspirin in patients with acute coronary syndrome and after percutaneous coronary intervention. Adverse effects such as bleeding and dyspnea have been associated with premature ticagrelor discontinuation, which may limit any potential advantage of ticagrelor over clopidogrel. The randomized trials of ticagrelor captured adverse events, offering the opportunity to more precisely quantify these effects across studies. Therefore, a meta-analysis of 4 randomized clinical trials of ticagrelor conducted between January 2007 and June 2017 was performed to quantify the incidence and causes of premature ticagrelor discontinuation. Among 66,870 patients followed for a median 18 months, premature ticagrelor discontinuation was seen in 25%; bleeding was the most common cause of discontinuation followed by dyspnea. Versus the comparators, the relative risk of dyspnea-related discontinuation during follow-up was 6.4-fold higher, the relative risk of bleeding was 3.2-fold higher, and the relative risk of discontinuation due to any adverse event was 59% higher for patients receiving ticagrelor. Understanding these potential barriers to adherence to ticagrelor is crucial for informed patient-physician decision making and can inform future efforts to improve ticagrelor adherence. This review discusses the incidence, causes, and biological mechanisms of ticagrelor-related adverse effects and offers strategies to improve adherence to ticagrelor.
替格瑞洛是急性冠脉综合征和经皮冠状动脉介入治疗后与阿司匹林联合应用的现代抗血栓治疗基石。出血和呼吸困难等不良反应与替格瑞洛过早停药有关，这可能限制了替格瑞洛相对于氯吡格雷的任何潜在优势。替格瑞洛的随机试验捕捉到了不良事件，为更精确地量化这些研究间的影响提供了机会。因此，对 2007 年 1 月至 2017 年 6 月期间进行的 4 项替格瑞洛随机临床试验进行了荟萃分析，以量化替格瑞洛过早停药的发生率和原因。在随访中位数为 18 个月的 66870 例患者中，25%的患者过早停药；出血是停药的最常见原因，其次是呼吸困难。与对照药物相比，随访期间因呼吸困难相关停药的相对风险高 6.4 倍，因出血相关停药的相对风险高 3.2 倍，因任何不良事件相关停药的相对风险高 59%。了解这些对替格瑞洛依从性的潜在障碍对于知情的医患决策至关重要，并可为改善替格瑞洛依从性的未来努力提供信息。这篇综述讨论了替格瑞洛相关不良事件的发生率、原因和生物学机制，并提供了提高替格瑞洛依从性的策略。
