4 Essential Pharmacotherapy Findings from ESC Congress 2016

AUGUST 30, 2016
Many exciting clinical trial results are being presented at the 2016 European Society of Cardiology (ESC) Congress and published simultaneously this week.
Here’s a sample of some of the more pharmacotherapy-focused research showcased at ESC:

1. PRAGUE-181
  • 1230 patients across 14 sites were randomly assigned to either prasugrel or ticagrelor before percutaneous coronary intervention (PCI).
  • Primary endpoint was death, reinfarction, urgent target vessel revascularization, stroke, and serious bleeding requiring transfusion or prolonging hospitalization at 7 days (to reflect primarily the inhospital phase).
  • The study was prematurely terminated for futility. The occurrence of the primary endpoint didn’t differ between groups receiving prasugrel and ticagrelor.
Key Takeaway
This head-to-head comparison of prasugrel and ticagrelor doesn’t support the hypothesis that one is more effective or safer than the other in preventing ischemic and bleeding events in the acute phase of myocardial infarction (MI) treated with primary PCI.

  • Ticagrelor reduced the risk of major adverse cardiovascular events (MACE) when added to low-dose aspirin in stable patients with prior MI, resulting in the approval of ticagrelor 60 mg twice-daily for long-term secondary prevention.
  • This study investigated the incidence of stroke, outcomes after stroke, and efficacy of ticagrelor, focusing on the approved dose for reducing stroke in this population.
  • Ticagrelor significantly reduced the risk of stroke, driven by a reduction in ischemic stroke.
  • Ticagrelor increased TIMI major bleeding but with no statistically significant increase in intracranial hemorrhage or fatal bleeding.
Key Takeaway
High-risk patients with prior MI are at risk for stroke, approximately one-third of which are fatal or lead to moderate-to-severe disability. The addition of ticagrelor 60 mg twice-daily significantly reduced this risk without an excess of hemorrhagic stroke, but with more major bleeding. In high-risk patients with coronary disease, more intensive antiplatelet therapy should be considered to reduce the risk of not only coronary events, but also stroke.

Douglas Jennings, PharmD, FCCP, FAHA
Douglas Jennings, PharmD, FCCP, FAHA
Douglas Jennings, PharmD, FCCP, FAHA, FACC, currently practices as the clinical pharmacy manager in heart transplant and mechanical circulatory support at New York Presbyterian Columbia University Medical Center. He is a past chair of the American College of Clinical Pharmacy (ACCP) Cardiology PRN, and he is a fellow of ACCP, the American Heart Association, and the American College of Cardiology.