Currently, ticagrelor, an anti-platelet medication, is added to aspirin for one year in patients presenting with a heart attack. However, the efficacy of long-term treatment has not been studied, and current practice guidelines recommend stopping ticagrelor after a year. New findings, led by researchers at Brigham and Women’s Hospital (BWH), indicate that treatment with ticagrelor in patients beyond one year after their heart attack reduces the risk of cardiovascular death, another heart attack, or stroke. These findings are presented at the American College of Cardiology’s 64th Annual Scientific Session and simultaneously published in the New England Journal of Medicine.
“Our results show that the use of ticagrelor beyond one year following a heart attack reduces the risk of further major cardiovascular events,” said Marc S. Sabatine, MD, MPH, principal investigator of this trial and chairman of the TIMI Study Group at BWH. “As expected with a blood thinner, we observed an increase in bleeding, but there was no excess of fatal bleeding or bleeding into the brain.”
In a double blind trial, named the PEGASUS-TIMI 54 study, researchers randomized 21,162 patients with a history of heart attack to receive ticagrelor 90mg twice daily, ticagrelor 60mg twice daily, or placebo. All patients also received a low-dose aspirin, and were followed for an average of 33 months. Researchers evaluated the occurrence of cardiovascular death, heart attack or stroke and major bleeding events.
Researchers found that both doses of ticagrelor significantly reduced the primary endpoint of cardiovascular death, heart attack or stroke compared to placebo, with a 15 percent reduction seen in the 90-mg group and a 16 percent reduction seen in the 60-mg group. Additionally, results were consistent for the individual components of the composite endpoint (cardiovascular death, another heart attack, or stroke), and were also consistent for patients regardless of age, sex, or type or timing of the prior heart attack.
“The rate of cardiovascular events-death, heart attack and stroke -that we observed continued to diverge over time between the ticagrelor arms and the placebo arm, suggesting that there is continued benefit to continued therapy,” said Sabatine.
Researchers also report that rates of major bleeding were higher in both ticagrelor groups when compared to placebo, but the rates of fatal bleeding or bleeding into the brain did not differ between the treatment and placebo groups. A mild or moderate sensation of shortness of breath, a known side effect, was more common with ticagrelor than placebo, and occurred early in treatment.