Table 5.
Safety and tolerability of low-dose versus standard-dose ticagrelor in East Asians
| References | Major bleeding (%) | Minor/minimal bleeding (%) | Dyspnea (%) | Any adverse events (%) | |
|---|---|---|---|---|---|
| Li et al, 201219 | None | Minor bleeding: Ticagrelor 90 mg 8.3% (epistaxis) Ticagrelor 180 mg 7.1% (gingival bleeding) |
Ticagrelor 90 mg 0% Ticagrelor 180 mg 21.4% |
Ticagrelor 90 mg 25.0% Ticagrelor 180 mg 50.0% |
|
| Hiasa et al, 201423 | Ticagrelor 45 mg 2% Ticagrelor 90 mg 0% Clopidogrel 75 mg 0% |
Minor bleeding: None Minimal bleeding: Ticagrelor 45 mg 26.0% Ticagrelor 90 mg 39.5% Clopidogrel 75 mg 21.7% |
Ticagrelor 45 mg 0% Ticagrelor 90 mg 4.7% Clopidogrel 75 mg 0% |
Ticagrelor 45 mg 56.0% Ticagrelor 90 mg 74.4% Clopidogrel 75 mg 47.8% |
|
| Bonaca et al, 20151 (PEGASUS-TIMI 54) | All patients | Ticagrelor 60 mg 2.3%, HR* 2.32 (95% CI 1.68–3.21) Ticagrelor 90 mg 2.6%, HR* 2.69 (95% CI 1.96–3.70) Placebo 1.1% |
Minor bleeding: Ticagrelor 60 mg 1.2%, HR* 3.31 (95% CI 1.94–5.63) Ticagrelor 90 mg 1.3%, HR* 4.15 (95% CI 2.47–7.00) Placebo 0.4% |
Ticagrelor 60 mg 15.8% Ticagrelor 90 mg 18.9% Placebo 6.4% |
Ticagrelor 60 mg 76.3% Ticagrelor 90 mg 76.9% Placebo 70.0% |
| Asians only | Ticagrelor 60 mg 3.7%, HR* 3.23 (95% CI 1.45–7.18) Ticagrelor 90 mg 3.0%, HR* 2.37 (95% CI 1.02–5.50) Placebo 1.4% |
N/A | N/A | N/A | |
| Li et al, 201521 | Ticagrelor 45 mg 4.6%, HR# 0.352 (95% CI 0.125–0.994) Ticagrelor 90 mg 12.1% Clopidogrel 75 mg 3.6% |
Minor bleeding: Ticagrelor 45 mg 5.6%, HR# 0.311 (95% CI 0.121–0.801) Ticagrelor 90 mg 15.9% Clopidogrel 75 mg 4.5% |
Ticagrelor 45 mg 3.7% Ticagrelor 90 mg 11.4% HR 1.086 (95% CI 0.952–1.237) Clopidogrel 75 mg N/A |
N/A | |
| Li et al, 201624 | None | Minor bleeding‡: Ticagrelor 45 mg 8.3% Ticagrelor 60 mg 16.7% Ticagrelor 90 mg 8.3% |
Ticagrelor 45 mg 0% Ticagrelor 60 mg 16.7% Ticagrelor 90 mg 8.3% |
Ticagrelor 45 mg 33.3% Ticagrelor 60 mg 33.3% Ticagrelor 90 mg 41.7% |
|
| Li et al, 201620 | None | Minimal bleeding: Ticagrelor 90 mg LD, 45 mg BID MD 10.0% Ticagrelor 180 mg LD, 90 mg BID MD 20.0% Clopidogrel 600 mg LD, 75 mg daily MD 0% |
None | Ticagrelor groups N/A Clopidogrel 600 mg LD, 75 mg daily MD 10.0% (sinus bradycardia) |
|
| Xue et al, 201622 | None | Minor bleeding: Ticagrelor 45 mg 0% Ticagrelor 90 mg 9.5% Clopidogrel 75 mg 0% |
Ticagrelor 45 mg 10.0% Ticagrelor 90 mg 14.3% Clopidogrel 75 mg 0% |
Ticagrelor 45 mg 15.0% Ticagrelor 90 mg 33.3% Clopidogrel 75 mg 0% |
Notes:
*
Compared to placebo;
#
compared to ticagrelor 90 mg; bleeding events compared to clopidogrel were not statistically significant (p>0.05);
‡
composite of several minor bleeding results (positive occult bleeding, hemoptysis, gingival bleeding, epistaxis).
Abbreviations: CI, confidence interval; HR, hazard ratio; N/A, not available; TIMI, thrombolysis in myocardial infarction; LD, loading dose; MD, maintenance dose.