Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, Florida.
Pharmacotherapy. 2019 Sep;39(9):912-920. doi: 10.1002/phar.2311. Epub 2019 Aug 7.
To compare the effectiveness and safety of ticagrelor versus prasugrel in preventing recurrent cardiovascular disease (CVD) and major bleeding events in patients with acute coronary syndrome (ACS).
Retrospective cohort analysis.
Truven Commercial and Medicare Supplemental claims database (2011-2016).
Study consisted of adults with ACS who newly initiated ticagrelor or prasugrel within 7 days of their first ACS diagnosis and had no prior use for at least 12 months; after propensity score matching, 10,073 patients were in each group.
The primary study outcomes, first occurrence of a recurrent nonfatal CVD event (composite of myocardial infarction and stroke) and occurrence of a major bleeding event, were compared between the ticagrelor and prasugrel groups. Secondary outcomes included occurrence of minor bleeding events, defined based on the presence of bleeding events in outpatient claims. Cox proportional hazards models after propensity score matching were used to obtain the hazard ratio (HR) and 95% confidence interval (CI). In the Cox proportional hazards model, the use of ticagrelor was associated with a decreased risk of recurrent nonfatal CVD events (HR 0.80, 95% CI 0.70-0.92) and major bleeding events (HR 0.54, 95% CI 0.41-0.70) compared with prasugrel. Additionally, the use of ticagrelor was associated with a lower risk of minor bleeding events compared with prasugrel (HR 0.71, 95% CI 0.65-0.78).
In this population-based cohort of incident ACS patients, ticagrelor was associated with a reduced rate of recurrent nonfatal CVD events, major and minor bleeding events compared with prasugrel.
比较替格瑞洛与普拉格雷在预防急性冠脉综合征（ACS）患者复发性心血管疾病（CVD）和主要出血事件方面的有效性和安全性。
回顾性队列分析。
Truven 商业和医疗保险补充索赔数据库（2011-2016 年）。
研究包括新开始使用替格瑞洛或普拉格雷的 ACS 成人患者，他们在首次 ACS 诊断后 7 天内使用，且至少在 12 个月内未使用过；在倾向评分匹配后，每组各有 10073 名患者。
主要研究结果是首次发生复发性非致死性 CVD 事件（心肌梗死和中风的复合事件）和发生主要出血事件的情况，比较替格瑞洛和普拉格雷组之间的差异。次要结果包括基于门诊索赔中出血事件的存在而定义的轻微出血事件的发生情况。使用倾向评分匹配后的 Cox 比例风险模型来获得风险比（HR）和 95%置信区间（CI）。在 Cox 比例风险模型中，与普拉格雷相比，使用替格瑞洛与复发性非致死性 CVD 事件（HR 0.80，95%CI 0.70-0.92）和主要出血事件（HR 0.54，95%CI 0.41-0.70）的风险降低相关。此外，与普拉格雷相比，使用替格瑞洛与轻微出血事件的风险降低相关（HR 0.71，95%CI 0.65-0.78）。
在本基于人群的 ACS 患者队列中，与普拉格雷相比，替格瑞洛与复发性非致死性 CVD 事件、主要和次要出血事件的发生率降低相关。
