ArticleJACC. Asia2025
Bleeding Outcomes of Ticagrelor Versus Clopidogrel in Acute Coronary Syndrome Patients: A Multiethnic Database Study.
Article in JACC. Asia, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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Who cites it
2 citing papers in PubMed.
- Ethnicity, P2YJACC. Asia · 2025Article
- Antiplatelet Therapy Tailored by Ethnicity: Further Insights From a Multiethnic Southeast Asian Cohort.JACC. Asia · 2025Article
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Authors and funding
9 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundCompared with Caucasians, East Asians with acute coronary syndrome (ACS) respond differently to P2Y
objectivesThe purpose of this study was to compare bleeding outcomes between ticagrelor and clopidogrel, and identify bleeding predictors in a multiethnic South-East Asian ACS cohort.
methodsWe conducted a retrospective, propensity-matched, nationwide database cohort study of ACS patients who underwent coronary revascularization in Singapore, and compared 1-year bleeding outcomes of ticagrelor and clopidogrel. Independent bleeding predictors were investigated using multivariate logistic regression analysis.
resultsBetween January 2013 and December 2017, 14,812 ACS patients (8,502 [57%] clopidogrel and 6,310 [43%] ticagrelor) were eligible for the study. Median follow-up was 12 months (Q1-Q3: 12-12 months). Ticagrelor was associated with higher risk of any clinically relevant bleeding (adjusted HR: 1.20; 95% CI: 1.02-1.40; P = 0.022), particularly Bleeding Academic Research Consortium (BARC) type 3 bleeding (adjusted HR: 1.33; 95% CI: 1.04-1.69; P = 0.023), compared with clopidogrel. Independent bleeding predictors were ticagrelor use, age ≥65 years, increasing comorbidities, chronic obstructive pulmonary disease, hyperlipidemia, severe chronic kidney disease, anemia, prior bleeding within 6 months, and concurrent oral anticoagulant use. Indians and "others" experienced lower bleeding odds than Chinese, while Malays and Chinese had similar odds.
conclusionsTicagrelor was associated with increased risk of BARC type 3 bleeding compared with clopidogrel. Novel risk factors Indian and "other" ethnicity appeared protective, while age ≥65 years, increasing comorbidities, chronic obstructive pulmonary disease, and hyperlipidemia were associated with increased bleeding odds. These novel bleeding risk factors warrant validation in a prospective study.
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