Deepak Bhatt, MD: Ticagrelor and Major Adverse Limb Events

March 25, 2020

A special edition ACC House Call with Deepak Bhatt, MD, to discuss the results of a meta-analysis looking at ticagrelor and MALE from 2 clinical trials.

A new analysis of patients from 2 major clinical trials is providing clinicians with more insight into the benefits of ticagrelor use in patients with atherosclerosis.

Using data from the randomized, double-blind PEGASUS-TIMI 54 and THEMIS trials found the use of the P2Y12 inhibitor not only reduces major adverse cardiovascular events but also cut the rate of major adverse limb events by 41%.

Presented at the American College of Cardiology’s Annual Scientific Session Together with World Congress of Cardiology (ACC.20/WCC), the analysis sought to examine the effect of ticagrelor on limb outcomes in those with atherosclerosis—with a particular interest in those with peripheral artery disease (PAD).

With this in mind, investigators from the University of Colorado and Brigham and Women’s Hospital conducted a meta-analysis using a fixed-effects model of patients from the aforementioned trials.

From THEMIS (19,220) and PEGASUS-TIMI 54 (21,162), investigators identified a cohort of 40,392 patients—in both trials, 150 first major adverse limb events were recorded. For patients randomized to placebo the event rate at 3 years in PEGASUS-TIMI 54 was 0.7% and in THEMIS the rate was 0.3%.

In a pooled analysis, ticagrelor reduced the risk of major adverse limb events by 41% (HR 0.59, 95% CI, 0.42-0.83, P = .002). Specifically, the risk of major adverse limb events was reduced by 35% (HR 0.65, 95% CI, 0.44-0.95, P = .002) in PEGASUS-TIMI 54 and by 55% (HR 0.45, 95% CI, 0.23-0.86, P = .002) in THEMIS.

For his interpretation of the results and how they can inform clinicians on the use of ticagrelor in a clinical setting, HCPLive® caught up with study investigator Deepak Bhatt, MD, executive director of Interventional Cardiovascular Programs at Brigham and Women’s Hospital, in a recent ACC House Call.

The study, “Ticagrelor and Major Adverse Limb Events: A Systematic Review and Meta-Analysis,” was presented at ACC.20.


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