Trial reportCMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne2025
Ticagrelor Compared to Clopidogrel in Acute Coronary Syndromes trial (TC4): a Bayesian pragmatic cluster randomized controlled trial.
Trial report in CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04057300 (Ticagrelor Compared to Clopidogrel in Acute Coronary Syndromes - the TC4 Comparative Effectiveness Study), which is not on this map. Cited by 1 paper.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Ticagrelor Compared to Clopidogrel in Acute Coronary Syndromes - the TC4 Comparative Effectiveness Study
Who cites it
1 citing paper in PubMed.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundDual antiplatelet therapy is the standard of care for acute coronary syndrome, but uncertainty exists regarding the optimal regimen for patients in North America. We sought to compare the effectiveness and safety of acetylsalicylic acid (ASA) and ticagrelor or clopidogrel in patients with acute coronary syndrome from a single tertiary academic centre in Montréal, Canada.
methodsWe conducted a pragmatic, open-label, time-clustered (bimonthly between October 2018 and March 2021), randomized controlled trial. The primary effectiveness end point was a composite of all-cause mortality, nonfatal myocardial infarction, or ischemic stroke. The primary safety end point was hospital admissions for bleeding. We ascertained 12-month outcomes from the Quebec universal electronic health databases. We designed and analyzed the study within a Bayesian paradigm to supplement existing knowledge. The primary analysis was a Bayesian logistic regression model with an informed focused prior from previously randomly assigned North American patients. Robustness was evaluated with vague and other prespecified informative priors, spanning reasonable pre-existing beliefs. We defined clinically important benefits and harms as risk reductions exceeding a 10% difference.
resultsWe randomly assigned 1005 patients with acute coronary syndrome to ticagrelor (
interpretationWhether we analyzed this trial with a vague or a range of reasonable informed priors, we found no strong evidence for the superiority of ticagrelor over clopidogrel in North American patients. Current guidelines favouring ticagrelor over clopidogrel might take this new evidence into future consideration.
trial registrationClinicaltrials.gov no. NCT04057300.
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