Platelet inhibition and patient outcomes

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Transcription de la présentation:

Platelet inhibition and patient outcomes PLATO Platelet inhibition and patient outcomes Walentin L. et al. New England Journal of Medicine 2009 ; 361 : 1045-57

PLATO Méthodologie Objectif Etude Critères d’inclusion Comparer le tiratéglor* au clopidogrel dans le traitement du syndrome coronarien aigu (SCA) avec ou sans sus décalage de ST. Etude Internationale, multicentrique, randomisée, double insu Critères d’inclusion Patients SCA ST+ ou ST- ATL (64%), PAC (10%) PLATO *Tiratéglor : anti-agrégant plaquettaire oral, 1er antagoniste réversible des récepteurs plaquettaires P2Y12 ATL : angioplastie transluminale PAC = pontage aorto-coronaire Walentin L. et al. New England Journal of Medicine 2009 ; 361 : 1045-57

Tiratéglor* + aspirine Clopidogrel** + aspirine Schéma de l’étude Patients SCA ST+ ou ST- ATL/PAC (n= 18 624) R Tiratéglor* + aspirine (n = 9933) Clopidogrel** + aspirine (n = 9 291) Critère de jugement principal Décès CV, IDM, AVC à 1 an Hémorragie sévère PLATO Suivi 12 mois * Tiratéglor : DC = 180 mg puis 90 mg x 2/j (6 à 12 mois) ** Clopidogrel : DC = 300 mg ± 300 mg puis 75 mg/j (6 à 12 mois) Walentin L. et al. New England Journal of Medicine 2009 ; 361 : 1045-57

Taux d’événem²ents (%) Résultats efficacité Critère Principal : décès CV, IDM, AVC à 1 an 12 Clopidogrel 11,7 10 9,8 PLATO 8 Ticagrelor Taux d’événem²ents (%) 6 4 2 RR 0,84 (IC95 : 0,77-0,92), p = 0,0003 60 120 180 240 300 360 Jours après randomisation Walentin L. et al. New England Journal of Medicine 2009 ; 361 : 1045-57

PLATO Résultats efficacité IDM Mortalité CV Clopidogrel Clopidogrel 7 6,9 7 Clopidogrel 6 6 5,8 5 5 Clopidogrel 5,1 PLATO 4 Ticagrelor 4 4 Taux d’événements (%) 3 3 Ticagrelor 2 2 1 1 RR : 0,84 (IC95 : 0,75-0,95), p = 0,005 RR : 0,79 (IC95 : 0,69-0,91), p = 0,001 60 120 180 240 300 360 60 120 180 240 300 360 Jours après randomisation Jours après randomisation Walentin L. et al. New England Journal of Medicine 2009 ; 361 : 1045-57

PLATO Résultats tolérance NS Walentin L. et al. New England Journal of Medicine 2009 ; 361 : 1045-57

Conclusion Sur près de 1000 syndromes coronariens aigus avec ou sans sus décalage de ST, le ticagrelor s’est révélé plus efficace que le clopidogrel : permettant d’éviter 14 décès, 11 IDM, et 6-8 thromboses stents sans surcroît hémorragique PLATO Walentin L. et al. New England Journal of Medicine 2009 ; 361 : 1045-57