The roughly 24,000 participants have been randomized to the potent platelet aggregation inhibitor ticagrelor at 90 or 60 mg b.i.d. or to placebo for a planned 28 months. All are on background daily aspirin. The expectation is that major bleeding, the primary safety endpoint, will be less of an issue than with vorapaxar.
Still, ticagrelor may not be the optimal potent antiplatelet drug for long-term use in combination with aspirin, in Dr. O’Gara’s view.
“There are issues, in our practice at least, with ticagrelor. It’s difficult for patients to take a medication twice a day. There’s some excess incidence of dyspnea, and an excess of bradycardia that can aggravate clinical outcomes in some patients. And there’s a signal of a possible increased risk of intracranial hemorrhage compared to clopidogrel,” he said.
The principal investigator in PEGASUS TIMI 54 is Dr. Marc S. Sabatine of Brigham and Women’s Hospital.
Dr. O’Gara reported having no financial conflicts.