PMID- 24127651
OWN - NLM
STAT- MEDLINE
DCOM- 20150624
LR  - 20211021
IS  - 1369-1635 (Electronic)
IS  - 0953-7104 (Print)
IS  - 0953-7104 (Linking)
VI  - 25
IP  - 7
DP  - 2014
TI  - Lower mortality following pulmonary adverse events and sepsis with ticagrelor 
      compared to clopidogrel in the PLATO study.
PG  - 517-25
LID - 10.3109/09537104.2013.842965 [doi]
AB  - In the PLATelet inhibition and patient Outcomes (PLATO) study of patients with 
      acute coronary syndromes, ticagrelor reduced mortality compared to clopidogrel 
      but the mechanisms for this mortality reduction remain uncertain. We analysed 
      adverse events (AEs) consistent with either pulmonary infection or sepsis, and 
      subsequent mortality, in 18,421 PLATO patients treated with ticagrelor or 
      clopidogrel. AEs occurring within 7 days of last dose of study medication were 
      defined as "on-treatment". Serial measurements of blood leukocyte counts, 
      C-reactive protein and interleukin-6 were performed. Fewer on-treatment pulmonary 
      AEs occurred in the ticagrelor compared to the clopidogrel group (275 vs. 331 
      respectively; p = 0.019), with fewer deaths following these AEs (33 vs. 71; 
      p < 0.001), particularly in those who remained on study medication three days 
      after AE onset (10 vs. 43; p < 0.001). There were fewer deaths attributed to 
      sepsis in the ticagrelor group (7 vs. 23; p = 0.003). Leukocyte counts were lower 
      in the clopidogrel group during treatment (p < 0.0001 at 1, 3 and 6 months) but 
      not at 1 month post-discontinuation. C-reactive protein increased more at 
      discharge in the ticagrelor group (28.0 +/- 38.0 vs. 26.1 +/- 36.6 mg/l; p < 0.001) 
      and interleukin-6 remained higher during the first month of treatment with 
      ticagrelor. We conclude that the mortality risk following pulmonary AEs and 
      sepsis in acute coronary syndrome patients appears to be lower during ticagrelor 
      compared to clopidogrel therapy. Further work should assess whether ticagrelor 
      and clopidogrel have differential effects on immune signalling.
FAU - Storey, Robert F
AU  - Storey RF
AD  - Department of Cardiovascular Science, University of Sheffield , Sheffield , UK .
FAU - James, Stefan K
AU  - James SK
FAU - Siegbahn, Agneta
AU  - Siegbahn A
FAU - Varenhorst, Christoph
AU  - Varenhorst C
FAU - Held, Claes
AU  - Held C
FAU - Ycas, Joseph
AU  - Ycas J
FAU - Husted, Steen E
AU  - Husted SE
FAU - Cannon, Christopher P
AU  - Cannon CP
FAU - Becker, Richard C
AU  - Becker RC
FAU - Steg, Ph Gabriel
AU  - Steg PG
FAU - Asenblad, Nils
AU  - Asenblad N
FAU - Wallentin, Lars
AU  - Wallentin L
LA  - eng
PT  - Journal Article
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
DEP - 20131015
PL  - England
TA  - Platelets
JT  - Platelets
JID - 9208117
RN  - 0 (Platelet Aggregation Inhibitors)
RN  - A74586SNO7 (Clopidogrel)
RN  - GLH0314RVC (Ticagrelor)
RN  - K72T3FS567 (Adenosine)
RN  - OM90ZUW7M1 (Ticlopidine)
SB  - IM
MH  - Adenosine/administration & dosage/adverse effects/*analogs & derivatives
MH  - Aged
MH  - Clopidogrel
MH  - Coronary Artery Disease/blood/*drug therapy/mortality
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Platelet Aggregation Inhibitors/administration & dosage/*adverse effects
MH  - Pneumonia/*chemically induced/mortality
MH  - Sepsis/*chemically induced/mortality
MH  - Ticagrelor
MH  - Ticlopidine/administration & dosage/adverse effects/*analogs & derivatives
MH  - Treatment Outcome
PMC - PMC4220996
OTO - NOTNLM
OT  - Clopidogrel
OT  - coronary artery disease
OT  - platelet aggregation inhibitors
OT  - pneumonia
OT  - sepsis
OT  - ticagrelor
EDAT- 2013/10/17 06:00
MHDA- 2015/06/25 06:00
CRDT- 2013/10/17 06:00
PHST- 2013/10/17 06:00 [entrez]
PHST- 2013/10/17 06:00 [pubmed]
PHST- 2015/06/25 06:00 [medline]
AID - 10.3109/09537104.2013.842965 [doi]
PST - ppublish
SO  - Platelets. 2014;25(7):517-25. doi: 10.3109/09537104.2013.842965. Epub 2013 Oct 
      15.