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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
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1 to 1 of 1 Research Studies DisplayedMarcaccio CL, Patel PB, Liang P
Efficacy and safety of perioperative dual antiplatelet therapy with ticagrelor versus clopidogrel in carotid artery stenting.
This study’s objective was to compare the efficacy and safety of perioperative dual antiplatelet therapy with aspirin/ticagrelor vs aspirin/clopidogrel in patients undergoing transfemoral carotid artery stenting (tfCAS) or transcarotid artery revascularization (TCAR). The authors identified all patients who underwent tfCAS or TCAR in the Vascular Quality Initiative registry from January 2016 to March 2021. They stratified patients by procedure and assessed outcomes using 1:3 propensity score-matched cohorts of patients who received perioperative aspirin/ticagrelor vs aspirin/clopidogrel. Among the cohort of 17,731 tfCAS patients, 593 (3.3%) received aspirin/ticagrelor and 11,404 (64%) received aspirin/clopidogrel. For the 2065 matched patients, no significant differences were found in the composite endpoint of stroke/death (aspirin/ticagrelor, 4.1%; vs aspirin/clopidogrel, 2.6%) or in the individual endpoints of stroke (2.9% vs 1.8%) or death (1.7% vs 1.1%). However, aspirin/ticagrelor was associated with a higher risk of bleeding (5.8% vs 2.8%). In a subgroup analysis of 297 tfCAS patients (14%) who received intraoperative protamine, no differences remained in stroke/death (1.5% vs 3.9%), and there was no longer a difference in bleeding (3.0% vs 2.6%). Among 17,946 TCAR patients, 453 (2.5%) received aspirin/ticagrelor and 13,696 (76%) received aspirin/clopidogrel. With the 1618 matched patients, no differences were found in stroke/death (0.7% vs 1.4%), stroke (0.2% vs 1.2%), death (0.5% vs 0.2%), or bleeding (1.2% vs 1.6%). For the 1429 TCAR patients (88%) who received protamine, no differences were found in stroke/death (0.8% vs 1.2%) or bleeding (0.6% vs 1.4%).
AHRQ-funded; HS027285.
Citation: Marcaccio CL, Patel PB, Liang P .
Efficacy and safety of perioperative dual antiplatelet therapy with ticagrelor versus clopidogrel in carotid artery stenting.
J Vasc Surg 2022 Apr; 75(4):1293-303.e8. doi: 10.1016/j.jvs.2021.09.045..
Keywords: Cardiovascular Conditions, Medication, Stroke, Adverse Drug Events (ADE), Adverse Events, Patient Safety, Surgery