ticlopidine and Non-ST-Elevation Myocardial Infarction studies

Ticlopidine: An effective inhibitor of platelet aggregation commonly used in the placement of STENTS in CORONARY ARTERIES.
ticlopidine : A thienopyridine that is 4,5,6,7-tetrahydrothieno[3,2-c]pyridine in which the hydrogen attached to the nitrogen is replaced by an o-chlorobenzyl group.

Research Excerpts

Excerpt	Relevance	Reference
"The Targeted Platelet Inhibition to Clarify the Optimal Strategy to Medically Manage Acute Coronary Syndromes trial enrolled 9326 participants with ACS, who received aspirin plus clopidogrel or prasugrel."	9.22	Ascertainment, classification, and impact of neoplasm detection during prolonged treatment with dual antiplatelet therapy with prasugrel vs. clopidogrel following acute coronary syndrome. ( Armstrong, PW; Beaven, AW; Blackwell, KL; Cyr, DD; Eckart, D; Fox, KA; Houterloot, L; Morse, MA; Ohman, EM; Onken, JE; Prabhakaran, D; Ready, NE; Roe, MT; Schulte, PJ; Strickler, JH; White, HD; Winters, KJ; Wiviott, SD; Zafar, SY; Zamoryakhin, D, 2016)
"Ticagrelor can lower the resting heart rate of patients and cause bradyarrhythmias in the 12th month after PCI."	7.83	Ticagrelor vs. clopidogrel in non-ST-elevation acute coronary syndromes. ( Dong, C; Liu, X; Ren, C; Ren, Q; Zhang, X, 2016)
"In 6763 medically managed non-ST-segment elevation ACS patients randomized in TRILOGY ACS (Targeted Platelet Inhibition to Clarify the Optimal Strategy to Medically Manage Acute Coronary Syndromes) (prasugrel versus clopidogrel), we examined relationships between categories of peak troponin/upper limit of normal (ULN) ratio within 48 hours of the index ACS event (≈4."	5.24	Relationship Between Peak Troponin Values and Long-Term Ischemic Events Among Medically Managed Patients With Acute Coronary Syndromes. ( Brown, EB; Cyr, DD; Goldstein, SA; Hamm, CW; Lüscher, TF; Neely, M; Newby, LK; Ohman, EM; Roe, MT; White, HD, 2017)
"The Targeted Platelet Inhibition to Clarify the Optimal Strategy to Medically Manage Acute Coronary Syndromes trial enrolled 9326 participants with ACS, who received aspirin plus clopidogrel or prasugrel."	5.22	Ascertainment, classification, and impact of neoplasm detection during prolonged treatment with dual antiplatelet therapy with prasugrel vs. clopidogrel following acute coronary syndrome. ( Armstrong, PW; Beaven, AW; Blackwell, KL; Cyr, DD; Eckart, D; Fox, KA; Houterloot, L; Morse, MA; Ohman, EM; Onken, JE; Prabhakaran, D; Ready, NE; Roe, MT; Schulte, PJ; Strickler, JH; White, HD; Winters, KJ; Wiviott, SD; Zafar, SY; Zamoryakhin, D, 2016)
"Ticagrelor can lower the resting heart rate of patients and cause bradyarrhythmias in the 12th month after PCI."	3.83	Ticagrelor vs. clopidogrel in non-ST-elevation acute coronary syndromes. ( Dong, C; Liu, X; Ren, C; Ren, Q; Zhang, X, 2016)

Research

Studies (11)

Authors

Clinical Trials (1)

Trial Overview

Trial Outcomes

Percentage of Participants With a Composite Endpoint of All-cause Death, MI, or Stroke

Timeframe	Studies, this research(%)	All Research%
pre-1990	0 (0.00)	18.7374
1990's	0 (0.00)	18.2507
2000's	0 (0.00)	29.6817
2010's	10 (90.91)	24.3611
2020's	1 (9.09)	2.80

Authors	Studies
Patel, A	1
Goodman, SG	2
Tan, M	1
Suskin, N	1
McKelvie, R	1
Mathew, AL	1
Lutchmedial, S	2
Dehghani, P	2
Lavoie, AJ	1
Huynh, T	1
Lavi, S	2
Philipp, R	1
Khan, R	1
Yan, AT	1
Radhakrishnan, S	1
Sedlak, T	1
Brunner, N	1
Kim, HH	1
Cieza, T	2
Kassam, S	1
Fordyce, CB	1
Heffernan, M	1
Jedrzkiewicz, S	1
Madan, M	1
Ahmed, S	1
Barry, C	1
Dery, JP	2
Bagai, A	1
Goldstein, SA	1
Newby, LK	1
Cyr, DD	2
Neely, M	1
Lüscher, TF	1
Brown, EB	1
White, HD	4
Ohman, EM	4
Roe, MT	4
Hamm, CW	1
Kern, A	1
Gil, RJ	1
Bojko, K	1
Sienkiewicz, E	1
Januszko-Giergielewicz, B	1
Górny, J	1
Bil, J	1
Castini, D	1
Persampieri, S	1
Cazzaniga, S	1
Ferrante, G	1
Centola, M	1
Lucreziotti, S	1
Salerno-Uriarte, D	1
Sponzilli, C	1
Carugo, S	1
Ren, Q	1
Ren, C	1
Liu, X	1
Dong, C	1
Zhang, X	2
Eckart, D	1
Schulte, PJ	1
Morse, MA	1
Blackwell, KL	1
Ready, NE	1
Zafar, SY	1
Beaven, AW	1
Strickler, JH	1
Onken, JE	1
Winters, KJ	2
Houterloot, L	1
Zamoryakhin, D	1
Wiviott, SD	1
Prabhakaran, D	3
Fox, KA	3
Armstrong, PW	3
Kagawa, Y	1
Shiode, N	1
Kawase, T	1
Tamekiyo, H	1
Okimoto, T	1
Hayashi, Y	1
Hagström, E	1
Hafley, G	1
Neely, ML	1
Sidhu, MS	1
Boden, WE	1
Wang, L	1
Bi, Y	1
Cao, M	1
Ma, R	1
Wu, X	1
Zhang, Y	2
Ding, W	1
Liu, Y	1
Yu, Q	1
Jiang, H	1
Sun, Y	1
Tong, D	1
Guo, L	1
Dong, Z	1
Tian, Y	1
Kou, J	1
Shi, J	1
Cornel, JH	1
Neely, B	1
Jakubowski, JA	1
Bhatt, DL	1
Ardissino, D	1
Erlinge, D	1
Tantry, US	1
Gurbel, PA	1
Mehta, SR	1
Fisher, HN	1
Zhu, YE	1
Welsh, RC	1
Henderson, MA	1
Siega, AJ	1
Cheema, AN	1
Wong, BY	1
Kokis, A	1

Trial	Phase	Enrollment	Study Type	Start Date	Status
A Comparison of Prasugrel and Clopidogrel in Acute Coronary Syndrome Subjects With Unstable Angina/Non-ST-Elevation Myocardial Infarction Who Are Medically Managed[NCT00699998]	Phase 3	9,326 participants (Actual)	Interventional	2008-06-30	Completed
[information is prepared from clinicaltrials.gov, extracted Sep-2024]

The percentage of participants is the total number of participants experiencing an all-cause death, nonfatal MI, or nonfatal stroke divided by number of participants in the treatment arm. Endpoint events were adjudicated by the Clinical Endpoint Committee. (NCT00699998)
Timeframe: Randomization through end of study (30-month visit)

Percentage of Participants With a Composite Endpoint of Cardiovascular (CV) Death, Myocardial Infarction (MI), or Stroke

Intervention	percentage of participants with an event (Number)
Prasugrel: <75 Years of Age	10.61
Prasugrel: 75 Years of Age or Older	27.04
Clopidogrel: <75 Years of Age	11.12
Clopidogrel: 75 Years of Age or Older	26.83

The percentage of participants is the total number of participants experiencing a CV death, nonfatal MI, or nonfatal stroke divided by number of participants in the treatment arm multiplied by 100. Endpoint events were adjudicated by the Clinical Endpoint Committee. (NCT00699998)
Timeframe: Randomization through end of study (30-month visit)

Percentage of Participants With a Composite Endpoint of CV Death and MI

Intervention	percentage of participants with an event (Number)
Prasugrel: <75 Years of Age	10.06
Prasugrel: 75 Years of Age or Older	24.64
Clopidogrel: <75 Years of Age	10.96
Clopidogrel: 75 Years of Age or Older	24.13

The percentage of participants is the total number of participants experiencing a CV death or nonfatal MI divided by number of participants in the treatment arm. Endpoint events were adjudicated by the Clinical Endpoint Committee. (NCT00699998)
Timeframe: Randomization through end of study (30-month visit)

Percentage of Participants With a Composite Endpoint of CV Death, MI, Stroke, or Re-hospitalization for Recurrent Unstable Angina (UA)

Intervention	percentage of participants with an event (Number)
Prasugrel: <75 Years of Age	9.61
Prasugrel: 75 Years of Age or Older	22.53
Clopidogrel: <75 Years of Age	10.21
Clopidogrel: 75 Years of Age or Older	22.69

The percentage of participants is the total number of participants experiencing a CV death, nonfatal MI, nonfatal stroke or re-hospitalization for a recurrent UA divided by number of participants in the treatment arm. Endpoints events were adjudicated by the Clinical Endpoint Committee. (NCT00699998)
Timeframe: Randomization through end of study (30-month visit)

Biomarker Measurements of Inflammation/Hemodynamic Stress: Brain Natriuretic Peptide (BNP)

Intervention	percentage of participants with an event (Number)
Prasugrel: <75 Years of Age	12.13
Prasugrel: 75 Years of Age or Older	26.27
Clopidogrel: <75 Years of Age	12.83
Clopidogrel: 75 Years of Age or Older	25.67

Brain natriuretic peptide (BNP) is secreted by the ventricles of the heart in response to hemodynamic stress and is a biomarker associated with increased CV risk. Results are presented as geometric least squares means (Geometric LS means). Geometric LS means were adjusted for treatment + baseline value + clopidogrel status at randomization. (NCT00699998)
Timeframe: Day 30 and 6 Months

Biomarker Measurements of Inflammation/Hemodynamic Stress: C-Reactive Protein (CRP)

Intervention	picograms per milliliter (pg/mL) (Geometric Mean)
	Day 30	6 Months (n=725, 125, 701, 174)
Clopidogrel: <75 Years of Age	319.345	250.982
Clopidogrel: 75 Years of Age or Older	951.359	722.750
Prasugrel: <75 Years of Age	313.494	253.434
Prasugrel: 75 Years of Age or Older	1082.396	770.132

C-Reactive Protein (CRP) is a biomarker associated with inflammation and increased CV risk. Results are presented as geometric least squares means (Geometric LS means). Geometric LS means were adjusted for treatment + baseline value + clopidogrel status at randomization. (NCT00699998)
Timeframe: Day 30 and Month 6

Economic and Quality of Life Outcomes

Intervention	milligrams per liter (mg/L) (Geometric Mean)
	Day 30	6 Months (n=755, 143, 745, 178)
Clopidogrel: <75 Years of Age	2.287	2.149
Clopidogrel: 75 Years of Age or Older	2.226	1.543
Prasugrel: <75 Years of Age	2.330	2.272
Prasugrel: 75 Years of Age or Older	2.441	1.593

Seattle Angina Questionnaire (SAQ) is a validated, disease-specific questionnaire containing 11 questions (Q) yielding 5 summary scales related to angina: physical limitations, angina stability, angina frequency, treatment satisfaction and disease perception. In this study only angina frequency and the physical limitations scales were assessed. Anginal Frequency was assessed using Q3 and Q4 which consists of a Likert scale ranging from 1 to 6 (higher values equals better quality of life) to assess how often a patient is having symptoms now. Physical limitations was assessed using Q1 which contains 9 items each assessed via Likert scale ranging from 1 to 6 (higher values equals better quality of life) to assess how much a participant's condition is hampering their ability to do what they want to do. Scale scores are transformed to a 0-100 by subtracting the lowest possible score, dividing by the range of the scale, and multiplying by 100. Higher values equal better quality of life. (NCT00699998)
Timeframe: Baseline and follow-up (24 months)

Genotyping Related to Drug Metabolism

Intervention	units on a scale (Mean)
	Baseline, physical limitations	Baseline, angina frequency	24 Months, physical limitations (n=420, 412)	24 Months, angina frequency (n=420, 412)
Clopidogrel	67.0	73.1	74.5	89.5
Prasugrel	67.8	73.6	75.1	89.7

Variation in the genes encoding the cytochrome P450 (CYP) enzymes (CYP2C19) can reduce the ability to metabolize clopidogrel and a reduced platelet response and have been associated with increased rates of CV events including CV death. Participants were classified as extensive metabolizers (EM); reduced metabolizers (RM); or unknown (UNK) metabolizers based on their CYP2C19 genotype. Possible extensive metabolizer (EM) phenotypes include EM=extensive metabolizer, UM=ultra-rapid metabolizer, and EM (non-UM) that are not UM. Possible reduced metabolizer (RM) phenotypes include IM=intermediate metabolizer and PM=poor metabolizer. Genotypes associated with each predicted phenotype are presented; predicted phenotype is presented first followed by the genotype. Percentage=(number of participants with the predicted phenotype and genotype divided by the total number of participants per arm) multiplied by 100. (NCT00699998)
Timeframe: Baseline

Platelet Aggregation Measures

Intervention	percentage participants with geneotype (Number)
	UM, 1/17	UM, 17/17	EM (non-UM), 1/1	IM, 1/2	IM, 1/3	IM, 1/4	IM, 1/6	IM, 1/8	PM, 2/2	PM, 2/3	PM, 2/4	PM, 2/6	PM, 2/8	PM, 3/3	UNK, 1/10	UNK, 1/13	UNK, 1/9	UNK, 1/9, 9/17	UNK, 13/17	UNK, 2/13	UNK, 2/17	UNK, 2/9	UNK, 3/17	UNK, 4/17	UNK, 4/9	UNK, 6/17	UNK, 8/17	UNK, 9/17	UNK, Undefined genotype
Clopidogrel: <75 Years of Age	25.1	5.4	35.7	19.8	0.5	0.1	0.0	0.4	4.3	0.3	0.2	0.0	0.0	0.2	0.1	0.0	0.0	0.0	0.0	0.0	6.8	0.1	0.0	0.2	0.0	0.0	0.1	0.0	0.5
Clopidogrel: 75 Years of Age or Older	21.8	4.3	41.2	19.7	0.6	0.3	0.2	0.3	3.8	0.3	0.2	0.0	0.0	0.0	0.0	0.0	0.0	0.0	0.0	0.0	6.2	0.0	0.3	0.0	0.0	0.2	0.0	0.0	0.6
Prasugrel: <75 Years of Age	24.0	5.1	38.8	18.6	0.8	0.4	0.0	0.1	3.9	0.3	0.0	0.0	0.0	0.0	0.0	0.0	0.1	0.0	0.0	0.0	6.3	0.0	0.1	0.2	0.0	0.0	0.2	0.0	0.7
Prasugrel: 75 Years of Age or Older	25.0	3.6	42.1	18.3	0.6	0.0	0.2	0.5	2.2	0.2	0.2	0.0	0.0	0.0	0.0	0.2	0.2	0.0	0.0	0.0	6.1	0.0	0.0	0.2	0.0	0.0	0.0	0.0	0.6

Platelet aggregation was measured by as measured by Accumetrics Verify Now™ P2Y12. Results were reported in P2Y12 Reaction Units (PRU). PRU represents the rate and extent of adenosine (ADP)-stimulated platelet aggregation. Lower values indicate greater P2Y12 platelet inhibition and lower platelet activity and aggregation. ANCOVA Model was used and values were corrected for treatment + baseline value + clopidogrel status at randomization. (NCT00699998)
Timeframe: Day 30 and 12 Months

Summary of All Deaths

Intervention	P2Y12 Reaction Units (PRU) (Least Squares Mean)
	Day 30	Month 12 (n=386, 76, 400, 103)
Clopidogrel: <75 Years of Age	193.489	199.003
Clopidogrel: 75 Years of Age or Older	200.285	181.360
Prasugrel: <75 Years of Age	93.280	94.529
Prasugrel: 75 Years of Age or Older	151.872	135.096

All deaths, regardless of possible relatedness, with the exception of 1 event, were adjudicated by the Clinical Endpoint Committee (CEC) and are reported in this table. The 1 event which was not adjudicated was a result of the revocation of consent by the participant prior to their death. Deaths possibly related to study drug in the opinion of the investigator are also contained in the Serious Adverse Event (SAE) module. (NCT00699998)
Timeframe: Randomization through end of study (30-month visit)

Trials

Other Studies

8 other studies available for ticlopidine and Non-ST-Elevation Myocardial Infarction

Article	Year
Contemporary use of guideline-based higher potency P2Y12 receptor inhibitor therapy in patients with moderate-to-high risk non-ST-segment elevation myocardial infarction: Results from the Canadian ACS reflective II cross-sectional study. Clinical cardiology, 2021, Volume: 44, Issue:6 Topics: Canada; Cross-Sectional Studies; Humans; Myocardial Infarction; Non-ST Elevated Myocardial Infarctio	2021
Platelet distribution width as the prognostic marker in coronary bifurcation treatment. European journal of clinical investigation, 2017, Volume: 47, Issue:7 Topics: Aged; Aspirin; Blood Platelets; Clopidogrel; Coronary Artery Disease; Drug-Eluting Stents; Female; H	2017
Real-world clopidogrel utilization in acute coronary syndromes: patients selection and outcomes in a single-center experience. Therapeutic advances in cardiovascular disease, 2017, Volume: 11, Issue:12 Topics: Acute Coronary Syndrome; Adenosine; Aged; Aged, 80 and over; Chi-Square Distribution; Clopidogrel; D	2017
Ticagrelor vs. clopidogrel in non-ST-elevation acute coronary syndromes. Herz, 2016, Volume: 41, Issue:3 Topics: Acute Coronary Syndrome; Adenosine; Bradycardia; Clopidogrel; Comorbidity; Electrocardiography; Fema	2016
A case of subacute stent thrombosis after drug-coated balloon coronary angioplasty for in-stent restenosis under single anti-platelet therapy. Cardiovascular intervention and therapeutics, 2017, Volume: 32, Issue:2 Topics: Aged; Angioplasty, Balloon, Coronary; Coronary Angiography; Coronary Restenosis; Coronary Vessels; D	2017
Microparticles and blood cells induce procoagulant activity via phosphatidylserine exposure in NSTEMI patients following stent implantation. International journal of cardiology, 2016, Nov-15, Volume: 223 Topics: Aged; Aspirin; Blood Cells; Blood Coagulation; Cell-Derived Microparticles; Clopidogrel; Female; Hum	2016
Relationship of Platelet Reactivity With Bleeding Outcomes During Long-Term Treatment With Dual Antiplatelet Therapy for Medically Managed Patients With Non-ST-Segment Elevation Acute Coronary Syndromes. Journal of the American Heart Association, 2016, 11-04, Volume: 5, Issue:11 Topics: Acute Coronary Syndrome; Aged; Angina, Unstable; Aspirin; Blood Platelets; Clopidogrel; Drug Therapy	2016
Baseline characteristics, adenosine diphosphate receptor inhibitor treatment patterns, and in-hospital outcomes of myocardial infarction patients undergoing percutaneous coronary intervention in the prospective Canadian Observational AntiPlatelet sTudy (C American heart journal, 2016, Volume: 181 Topics: Adenosine; Adult; Aged; Aged, 80 and over; Canada; Clopidogrel; Drug Substitution; Emergency Medical	2016

Intervention	participants (Number)
	Congestive Heart Failure	Cardiogenic Shock	Cardiac Rupture	Myocardial Infarction	Dysrhythmia	Stent Thrombosis	Directly Related to Revascularization-CABG or PCI	Intracranial Hemorrhage	Non-Hemorrhagic Stroke	Sudden death due to cardiovascular event	Pulmonary Embolism	Stroke, unknown type	Other Cardiovascular Event	Cardiovascular event, unknown type	Accidental	Trauma	Hemorrhage, not intracranial	Infection	Malignancy	Suicide	Other Non-Cardiovascular event	Cause unknown (nonadjudicated event)
Clopidogrel: <75 Years of Age	13	10	0	24	6	0	1	4	4	70	2	0	0	45	1	0	0	16	14	0	8	0
Clopidogrel: 75 Years of Age or Older	23	9	0	21	3	0	1	1	3	43	1	0	1	45	1	1	4	17	11	0	6	0
Prasugrel: <75 Years of Age	10	8	0	16	5	0	1	2	4	75	0	0	6	40	1	2	1	14	14	1	8	0
Prasugrel: 75 Years of Age or Older	21	4	1	24	2	0	1	1	4	39	1	1	1	41	0	3	1	21	7	0	4	1