Clopidogrel compared with other antiplatelet agents for secondary prevention of vascular events in adults undergoing percutaneous coronary intervention: clinical and cost-effectiveness analyses

Chen SY, Russell E, Banerjee S, Hutton B, Brown A, Asakawa K, McGahan L, Clark M, Severn M, Cox J, Sharma M
Record ID 32010001780
English
Authors' recommendations: The estimates of relative effectiveness for clopidogrel and ticlopidine with ASA suggest that the optimal therapeutic choice is unclear. Clopidogrel and ticlopidine are at least as effective as ASAfor the secondary prevention of vascular events, and could be more effective. Compared with ASA, clopidogrel, and especially ticlopidine, are associated with a higher risk of major bleeds. Areview of composite end point data (such as death, MI, stroke, revascularization, and major bleeds) suggests that the use of ASA plus clopidogrel reduced the rates of cardiovascular eventscompared with ASA alone. The use of clopidogrel was associated with fewer blood disorders compared with ticlopidine in a review of the composite end points data.Our economic evaluation showed that for patients undergoing PCI at age 60, one year of dual antiplatelet therapy with ticlopidine and ASA, followed by lifetime ASA, may be a more costeffectivetreatment (compared with clopidogrel plus ASA, and ASA monotherapy) for the secondary prevention of vascular events. There is hesitancy to prescribe ticlopidine to these patients because of the potentially fatal hematological disorders that are associated with its use. The dominance of this combination is lost when the costs of blood monitoring and occurrence of thrombotic thrombocytopenic purpura are factored into the model. Despite the economic attractiveness of this option, more clinical investigation of this drug is unlikely.
Details
Project Status: Completed
URL for project: http://www.cadth.ca/media/pdf/H2481_Clopidogrel_Percutaneous_Coronary_Intervention_tr_e.pdf
Year Published: 2010
URL for published report: http://www.cadth.ca/index.php/en/hta/reports-publications/search/publication/2708
English language abstract: An English language summary is available
Publication Type: Not Assigned
Country: Canada
MeSH Terms
  • Angioplasty, Balloon, Coronary
  • Platelet Aggregation Inhibitors
  • Ticlopidine
Contact
Organisation Name: Canadian Agency for Drugs and Technologies in Health
Contact Address: 600-865 Carling Avenue, Ottawa, ON K1S 5S8 Canada. Tel: +1 613 226 2553; Fax: +1 613 226 5392;
Contact Name: requests@cadth.ca
Contact Email: requests@cadth.ca
Copyright: Canadian Agency for Drugs and Technologies in Health (CADTH)
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