Antithrombotic therapy for long-term secondary prevention of acute coronary syndrome in high-risk patients.

10 , 24 , 28 – 30 Results from the TRITON-TIMI 38 trial suggested a possible trend toward a reduced efficacy benefit with prasugrel versus clopidogrel in women (relative risk reduction [RRR] in the primary efficacy end point: males 21% versus females 12%). 11 However, there was no indication from the published paper that this difference was statistically significant.

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In the PLATO trial, patients with elevated cardiac biomarkers showed a trend toward a greater benefit with ticagrelor versus clopidogrel for the primary efficacy end point: the composite of death from vascular causes, MI, or stroke (positive biomarker status, HR 0.85, 95% CI 0.77–0.94; negative biomarker status, HR 1.00, 95% CI 0.75–1.32). 10 Additionally, a recent PLATO subanalysis evaluating the relationship between biomarkers and the effect of ticagrelor compared with clopidogrel in patients with NSTE-ACS found that elevated high-sensitivity troponin T (Hs-TnT) was a predictor of cardiovascular events in patients managed noninvasively.

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