Ticagrelor versus clopidogrel in orally anticoagulated patients with acute coronary syndrome undergoing percutaneous coronary intervention
Main finding · MACE (mortality, MI, and stroke)Result — go to the resultAdjusted hazard ratio 1.02 95% CI 0.84–1.23Authors' conclusion
In ACS patients on DOACs undergoing PCI, ticagrelor was associated with an increased risk of bleeding compared with clopidogrel, with no differences in MACE, mortality, or MI.
Study context
- Population
- Patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) on dual antithrombotic treatment with direct oral anticoagulants (DOACs), January 2014 to February 2022median age 76 years, 69% males, 40% ST-segment elevation myocardial infarction
- Participants
- 3,708 patients
- Exposure
- Ticagrelor versus clopidogrel as part of dual antithrombotic treatment
- Ticagrelorn = 1,170
- Clopidogreln = 2,538reference
- Outcome
- Major adverse cardiovascular events (MACE):
- Mortality
- MI
- Stroke
- Follow-up
- Within one year
Methodological detailsSWEDEHEART registry, multivariate Cox regression, adjusted hazard ratios
- SWEDEHEART registry
- Multivariate Cox regression
- Adjusted hazard ratios
Main finding
As reported in the abstract
Adjusted hazard ratio
1.02
95% CI 0.84–1.23
By group
Ticagrelorvs clopidogrel
aHR 1.02 (95% CI 0.84–1.23)
Observational data: associations, not effects.
Further findings
| Outcome | Ticagrelor | Clopidogrel | aHR (95% CI) | |
|---|---|---|---|---|
| Mortality · within one year | 6.6% | 6.2% | 1.24 (0.91–1.69) | |
| MI · within one year | 10.4% | 11.2% | 0.90 (0.71–1.13) | |
| 0.512Adjusted hazard ratio (log scale) |
Safety
| Outcome | Ticagrelor | Clopidogrel | aHR (95% CI) | |
|---|---|---|---|---|
| Bleeding (clinically relevant bleeding) · within one year | 4.9% | 3.7% | 1.53 (1.06–2.22) | |
| 0.512Adjusted hazard ratio (log scale) |
Original publication
Ticagrelor versus clopidogrel in orally anticoagulated patients with acute coronary syndrome undergoing percutaneous coronary intervention. EuroIntervention. Published 15 May 2026. doi:10.
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