{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,30]],"date-time":"2025-10-30T16:26:03Z","timestamp":1761841563461,"version":"3.37.3"},"reference-count":31,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2017,11,5]],"date-time":"2017-11-05T00:00:00Z","timestamp":1509840000000},"content-version":"vor","delay-in-days":4,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Internal Medicine Journal"],"published-print":{"date-parts":[[2017,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background\/Aim<\/jats:title><jats:p>We studied clinical outcomes and discontinuation rates in a \u2018real\u2010world\u2019 population presenting with myocardial infarction treated with ticagrelor or clopidogrel.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Between January 2012 and May 2015, 992 patients with acute myocardial infarction undergoing invasive management and adequately pre\u2010treated with dual antiplatelet therapy were prospectively enrolled. Platelet aggregation was measured using the Multiplate analyser. Baseline characteristics, in\u2010hospital outcomes and 1\u2010year outcomes were collected.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Patients treated with ticagrelor were younger and less likely to be diabetic, have a previous myocardial infarction or present with a <jats:styled-content style=\"fixed-case\">ST<\/jats:styled-content>\u2010elevation myocardial infarction (all <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.05). Those treated with ticagrelor also had lower <jats:styled-content style=\"fixed-case\">CRUSADE<\/jats:styled-content> (Can Rapid risk stratification of Unstable angina patients Suppress <jats:styled-content style=\"fixed-case\">ADverse<\/jats:styled-content> outcomes with Early implementation of the <jats:styled-content style=\"fixed-case\">ACC<\/jats:styled-content>\/<jats:styled-content style=\"fixed-case\">AHA<\/jats:styled-content> guidelines; 20\u2009\u00b1\u20099.4 vs 23\u2009\u00b1\u200910.1, <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.0001) and <jats:styled-content style=\"fixed-case\">GRACE<\/jats:styled-content> (119\u2009\u00b1\u200928 vs 126\u2009\u00b1\u200932, <jats:italic>P<\/jats:italic>\u2009=\u20090.002) scores. High platelet reactivity was greatly reduced with ticagrelor compared to clopidogrel (16.1% vs 37.0%, respectively; <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.0001). Non\u2010coronary artery bypass grafting\u2010related thrombolysis in myocardial infarction major and minor bleeding occurred at similar rates in those treated with ticagrelor and clopidogrel. Rates of drug discontinuation in those treated with ticagrelor and clopidogrel were similar in hospital (20.2% vs 16.2%, <jats:italic>P<\/jats:italic>\u2009=\u20090.18) and between discharge and 1 year (29.9% vs 27.9%, <jats:italic>P<\/jats:italic>\u2009=\u20090.63). However, discontinuation due to dyspnoea, (3.3% vs 0%, <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.0001) and discontinuation due to any possible drug\u2010related adverse event (9.3% vs 2.2%, <jats:italic>P<\/jats:italic>\u2009=\u20090.0001) was more common in those treated with ticagrelor compared to clopidogrel<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Ticagrelor is paradoxically being used in lower\u2010risk patients rather than those most likely to benefit. Ticagrelor was associated with similar rates of bleeding but higher discontinuation rates due to adverse effects compared to clopidogrel.<\/jats:p><\/jats:sec>","DOI":"10.1111\/imj.13595","type":"journal-article","created":{"date-parts":[[2017,8,31]],"date-time":"2017-08-31T11:35:22Z","timestamp":1504179322000},"page":"1298-1305","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Contemporary antiplatelet therapy in acute coronary syndromes: are there differences in outcomes and discontinuation between clopidogrel and ticagrelor?"],"prefix":"10.1111","volume":"47","author":[{"given":"Scott A.","family":"Harding","sequence":"first","affiliation":[{"name":"Wellington Cardiovascular Research Group  Wellington New Zealand"},{"name":"Department of Cardiology Wellington Hospital  Wellington New Zealand"},{"name":"School of Biological Sciences Victoria University of Wellington  Wellington New Zealand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0469-134X","authenticated-orcid":false,"given":"Ana","family":"Holley","sequence":"additional","affiliation":[{"name":"Wellington Cardiovascular Research Group  Wellington New Zealand"},{"name":"Department of Surgery and Anaesthesia University of Otago, Wellington  Wellington New Zealand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ben","family":"Wilkins","sequence":"additional","affiliation":[{"name":"Wellington Cardiovascular Research Group  Wellington New Zealand"},{"name":"Department of Cardiology Wellington Hospital  Wellington New Zealand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah","family":"Fairley","sequence":"additional","affiliation":[{"name":"Wellington Cardiovascular Research Group  Wellington New Zealand"},{"name":"Department of Cardiology Wellington Hospital  Wellington New 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