- In subjects with type 2 diabetes (T2D) and acute coronary syndrome (AKS), those randomly assigned ticagrelor showed significantly lower rates of serious adverse cardiac events (MACE) and mortality.
- Light bleeding was significantly more common with ticagrelor, but severe bleeding was not.
Why this matters
- The guidelines recommend dual platelet aggregation inhibition (DAPT) with and .
- However, a more potent antiplatelet agent such as ticagrelor is required with a hyporesponsive response.
- There is little data comparing ticagrelor to T2D patients.
Study design
- Meta-analysis with 7 randomized trials comparing cardiovascular outcomes at 5,868 T2D patients with AKS randomized to ticagrelor (n = 1,944) vs. (n = 3,924).
- Funding: None
Key results
- Ticagrelor was associated with a significantly lower risk of MACE (mortality, myocardial infarction and revascularization; Risk ratio [RR]: 0.64; p = 0.001), significantly lower all-cause mortality (RR: 0.65; p = 0.0004) and significantly fewer cardiac death events (RR: 0.60; p = 0.003).
- Similar risk scores were found between the two agents for the risks of repeated revascularization (RR: 1.48; p = 0.53), stent thrombosis (RR: 0.70; p = 0.60), reinfarction (RR: 0.85; p = 0.39) and stroke (RR: 0.56; p = 0.41).
- ticagrelor was associated with a significantly higher risk of minor bleeding (RR: 1.53; p = 0.02).
- There was no difference for severe bleeding (RR: 1.08; p = 0.82).
- The results were consistent across all sensitivity analyses.
Limitations
- Limited number of cases
- Missing data for some clinical outcomes (d. h.dyspnea, heart failure) and for HbA1c.
- In 1 Study received some patients in addition to ticagrelor prasugrel.
- Follow-up periods varied between studies.
- Diabetes duration and other medications were not taken into account.
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