CLD status does not influence MACE, bleeding risks associated with ticagrelor vs clopidogrel

Use of ticagrelor compared with clopidogrel contributes to a similar risk of major adverse cardiovascular events (MACE) and a higher risk of major bleeding in acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI), reveals a study.

Such risks, however, do not vary with the patient’s chronic liver disease (CLD) status.

The authors used the Korean healthcare claims database to identify adult patients who underwent PCI and initiated ticagrelor or clopidogrel treatment within 7 days of an ACS diagnosis. They then categorized patients into mutually exclusive groups: those with CLD and those without.

Using a Cox proportional hazard model within a 1:1 propensity score (PS) matched cohort, the authors calculated the hazard ratios (HRs) of MACE and major bleeding associated with the two medications within each group.

Overall, 14,261 patients with CLD and 148,535 without CLD were included in the final analysis.

The risks of MACE (with CLD: HR, 1.01, 95 percent confidence interval [CI], 0.91‒1.13; without CLD: HR, 1.02, 95 percent CI, 0.98‒1.05; p=0.865 for heterogeneity) and major bleeding (with CLD: HR, 1.07, 95 percent CI, 0.71‒1.61; without CLD: 1.32, 95 percent CI, 1.15‒1.53; p=0.342 for homogeneity) for ticagrelor, compared with clopidogrel, did not differ with CLD status after PS matching.

“Among ACS patients undergoing PCI, the use of ticagrelor versus clopidogrel was associated with a similar risk of MACE and an increased risk of major bleeding, but these risks did not vary with CLD status,” the authors said.