6/29/23, 1:37 AM PLATO Pathway Feedback Search Clinical Topics Home Studies PLATO PLATO Disease Disease Non-ST-elevation myocardial inf ST-elevation myocardial infarction Trial question What is the effect of ticagrelor in patients with acute coronary syndromes? Study design Multi-center Double blinded RCT Population Characteristics of study participants 28.0% female N = 18624 72.0% male 18624 patients (5288 female, 13336 male) Inclusion criteria: patients admitted to the hospital with an acute coronary syndrome, with or without ST-segment elevation Key exclusion criteria: any contraindication against the use of clopidogrel, fibrinolytic therapy within 24 hours before randomization, need for oral anticoagulation therapy, increased risk of bradycardia, and concomitant therapy with a strong cytochrome P-450 3A inhibitor or inducer Interventions N=9333 ticagrelor (180 mg loading dose, 90 mg BID thereafter) N=9291 clopidogrel (300-600 mg loading dose, 75 mg daily thereafter) Primary outcome https://web.pathway.md/studies/recW5ucFTXxg5RJCQ 1/2 6/29/23, 1:37 AM PLATO Pathway Death from vascular causes, myocardial infarction, or stroke 11.7 % 11.7 9.8 8.8 % 5.8 % Significant decrease 2.9 % NNT = 53 0.0 % Ticagrelor Clopidogrel Significant decrease in death from vascular causes, myocardial infarction, or stroke (9.8% vs. 11.7%; HR 0.84, 95% CI 0.77 to 0.92) Secondary outcomes Significant decrease in myocardial infarction (5.8% vs. 6.9%; HR 0.84, 95% CI 0.75 to 0.95) Significant decrease in death from vascular causes (4% vs. 5.1%; HR 0.79, 95% CI 0.69 to 0.91) Significant decrease in death from any cause (4.5% vs. 5.9%; HR 0.78, 95% CI 0.69 to 0.89) Safety outcomes No significant differences in rates of major bleeding (11.6% vs. 11.2%, p=0.43). Significant differences in rates of major bleeding not related to CABG (4.5% vs. 3.8%, p = 0.03). Conclusion In patients admitted to the hospital with an acute coronary syndrome, with or without ST-segment elevation, ticagrelor was superior to clopidogrel with respect to death from vascular causes, myocardial infarction, or stroke. Reference Wallentin L, Becker RC, Budaj A et al. Ticagrelor versus clopidogrel in patients with acute coronary syndromes. N Engl J Med. 2009 Sep 10;361(11):1045-57. Open reference URL https://web.pathway.md/studies/recW5ucFTXxg5RJCQ 2/2