According to the PLATO trial, ticagrelor compared to clopidogrel in ACS demonstrated which of the following key findings?

• A Similar major adverse cardiovascular events with increased bleeding risk
• B Reduced stent thrombosis only, without reduction in overall mortality
• C Benefit limited to patients undergoing PCI but not managed medically
• D Reduced cardiovascular death, MI, and stroke without significant increase in major bleeding ✓

Explanation

The PLATO trial showed ticagrelor reduced the primary composite endpoint of cardiovascular death, MI, and stroke by 16% relative risk reduction compared to clopidogrel in ACS (P<0.001), including a significant mortality benefit. Major bleeding (non-CABG related) was similar, though ticagrelor showed more non-procedure related bleeding. Crucially, ticagrelor's benefit was seen regardless of management strategy (PCI or medical). Its disadvantages include twice-daily dosing, dyspnoea (in ~15%), and avoidance in patients requiring thienopyridine therapy for platelet P2Y12 inhibition.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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Written and medically reviewed by the StethoPrep medical team.