Print Share Email Send Email Your Name (required) ! Example: John Doe Email Address (required) ! Error: Please enter a valid sender email address. Example: email@example.com CC Me Recipient Email Address (required) ! Separate multiple email address with semi-colons (up to 5). Subject Subject for your email. Message (Maximum characters: 1,000) Error: Please enter your name Error: Please enter your email address Error: Please enter a valid recipient email address. Example:firstname.lastname@example.org Thank you! Your email has been sent to: The recipient(s) will receive an email message that includes a link to the selected article. Recipients may need to check their spam filters or confirm that the address is safe. Return to: Send Another Email An error has occurred sending your email(s). Please try again later or contact an administrator at OnlineCustomer_Service@email.mheducation.com. Return to: Twitter Facebook Linkedin Reddit Get Citation Citation AMA Citation Sharma R, Baber U. Sharma R, Baber U Sharma, Raman, and Usman Baber. "Ticagrelor vs. Clopidogrel After Fibrinolytic Therapy in Patients with ST-Elevation Myocardial Infarction (TREAT): A Randomized Clinical Trial." Hurst's the Heart Updates, 24 May 2016. McGraw-Hill, New York, NY, 2016. AccessCardiology. http://accesscardiology.mhmedical.com/updatesContent.aspx?gbosid=424344§ionid=189592014 MLA Citation Sharma R, Baber U. Sharma R, Baber U Sharma, Raman, and Usman Baber.. "Ticagrelor vs. Clopidogrel After Fibrinolytic Therapy in Patients with ST-Elevation Myocardial Infarction (TREAT): A Randomized Clinical Trial." Hurst's the Heart Updates Fuster V. Fuster V Fuster, Valentin. New York, NY: McGraw-Hill, 2016, http://accesscardiology.mhmedical.com/updatesContent.aspx?gbosid=424344§ionid=189592014. Download citation file: RIS (Zotero) EndNote BibTex Medlars ProCite RefWorks Reference Manager Mendeley © Copyright Tools Clip Full Chapter Figures Only Tables Only Videos Only Supplementary Content Top Ticagrelor vs. Clopidogrel After Fibrinolytic Therapy in Patients with ST-Elevation Myocardial Infarction (TREAT): A Randomized Clinical Trial by Raman Sharma, MD; Usman Baber, MD, MS, + +Update to Chapter 40: ST-Segment Elevation Myocardial Infarction and Chapter 41: Antiplatelet and Anticoagulant Therapy in Acute Coronary Syndromes Study Summary + +In the PLATO study, ticagrelor significantly reduced the rate of death from vascular causes, myocardial infarction or stroke, compared with clopidogrel, among acute coronary syndrome patients. However, very few patients presenting with ST-segment elevation myocardial infarction (STEMI) undergoing pharmacologic reperfusion with fibrinolytics were included in this landmark trial. Accordingly, the TREAT investigators conducted a randomized, international, open-label trial with blinded outcome assessment that evaluated ticagrelor compared with clopidogrel in 3,799 patients who received fibrinolytic therapy for STEMI. Patients, of whom 90% had been pretreated with clopidogrel, were randomized to delayed ticagrelor versus clopidogrel at a median of 11 hours after fibrinolysis. The primary safety outcome of TIMI major bleeding had occurred in 0.73% of the ticagrelor group vs. 0.69% of the clopidogrel group (p<0.001 for noninferiority) at 30 days. Secondary efficacy outcomes of major adverse cardiovascular events were 4.0% with ticagrelor and 4.3% with clopidogrel (p = 0.57) (see accompanying Hurst’s Central Illustration). + Ticagrelor versus Clopidogrel in Acute Coronary Syndromes Graphic Jump LocationView Full Size|Favorite Figure|Download Slide (.ppt) Commentary + +Study Strengths: The main strength of this study is that it revisits an issue that is not as applicable to the PCI-capable world but continues to be the mainstay of therapy in certain parts of the world. In this context, this study suggests that ticagrelor is safe as a delayed therapy following fibrinolysis, however there are several caveats to note. +Study Limitations: Patients in this study were generally young, predominantly male, with few comorbid risk factors, precluding generalizability to an older and/or higher-bleeding risk cohort. Although the primary endpoint of non-inferiority was met, this result should be interpreted with caution given that the non-inferiority margin was wide and the event rate was much lower than expected. In regards to efficacy, the study was underpowered to formulate any definitive inference on the comparative efficacy with respect to ischemic events. +Next Steps/Clinical Perspective: Notwithstanding its limitations, findings from this study provide important insights on the comparative safety and efficacy of ticagrelor versus clopidogrel in a STEMI population that has not been adequately studied to date. This trial suggests that ticagrelor is non-inferior to clopidogrel following reperfusion with fibrinolytics with respect to 30-day bleeding.