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Ticagrelor Versus Clopidogrel in Patients With STEMI Treated With Fibrinolysis: A Retrospective Real-World Analysis
Session:
SESSÃO DE POSTERS 37 - DOENÇAS CARDIOVASCULARES - TERAPÊUTICA ANTITROMBÓTICA
Speaker:
Margarida Câmara Farinha
Congress:
CPC 2025
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.4 Acute Coronary Syndromes – Treatment
Session Type:
Cartazes
FP Number:
---
Authors:
Margarida Câmara Farinha; Inês Coutinho Dos Santos; Fabiana Duarte; André Viveiros Monteiro; Maria Inês Barradas; Luís Oliveira; António Fontes; Santos Serena; Carina Machado; Miguel Pacheco; Anabela Tavares; Dinis Martins
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong>Background:</strong> In remote locations, thrombolytic therapy provides a critical alternative for patients with ST-segment elevation myocardial infarction (STEMI) when percutaneous coronary intervention (PCI) is not immediately accessible. Clopidogrel remains the recommended choice during the peri-thrombolytic phase, primarily due to concerns regarding haemorrhagic complications. However, data on the use of ticagrelor in this setting remain limited.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong>Purpose:</strong> To compare outcomes between STEMI patients who underwent fibrinolysis with clopidogrel and ticagrelor.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong>Methods:</strong> We conducted a retrospective study of STEMI patients who underwent fibrinolysis between 2020 and 2023 and were subsequently transferred to our center for facilitated or rescue PCI. Patients were divided into two groups based on antiplatelet therapy: Group 1 with clopidogrel and Group 2 with ticagrelor. The primary endpoint was a combined outcome of cardiovascular mortality, myocardial infarction or stroke. The secondary endpoint was intrahospital haemorrhagic complications according to TIMI definition. </span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong>Results:</strong> A total of 154 patients were included (mean age 61.3 ± 12.6 years, 29% women): 78 with clopidogrel (Group 1) and 76 with Ticagrelor (Group 2). No differences were found between groups regarding hypertension (75.6% vs 64.5%, p=0.13), diabetes (29.5% vs 30.3%, p=0.92), dyslipidaemia (71.8% vs 58.7%, p=0.09), smoking (62.8% vs 71.1%, p=0.28), overweight (71.8% vs 75%, p=0.65), and previous coronary disease (12.8% vs 13.2%, p=0.95). Primary endpoint was observed without significant difference in 10.3% of patients in Group 1 and 9.2% in Group 2 (p=0.83). Regarding haemorrhagic complications, TIMI minimal bleeding was more frequent in Group 2 (16.7% vs 31.6%, p=0.03). However, rates of TIMI bleeding requiring medical attention and major bleeding were comparable between the groups (3.8% vs 3.9%, p=0.97 and 1.3% vs 1.3%, p=0.99 respectively). </span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong>Conclusion: </strong>In our real-world remote setting, ticagrelor demonstrated a similar efficacy and safety profile compared to clopidogrel as adjunctive therapy of fibrinolysis in STEMI patients. Its use in the peri-thrombolytic phase could potentially simplify treatment protocols by eliminating the need to switch antiplatelet therapy.</span></span></p>
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