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Ticagrelor versus clopidogrel in patients with acute coronary syndromes


Landmark Series
Methodology: 4.5/5       
Usefulness: 4.5/5 

Wallentin L, Becker RC, Budaj A, Cannon CP, Emanuelsson H, Held C, Horrow J, Husted S, James S, Katus H, Mahaffey KW, Scirica BM, Skene A, Steg PG, Storey RF, Harrington RA; PLATO Investigators, Freij A, Thorsén M.
N Engl J Med. 2009 Sep 10;361(11):1045-57


PLATO was a multicentre, randomized, double-dummy, double blind trial conducted to determine if ticagrelor is superior to clopidogrel for the prevention of vascular events and death in patients with ACS and the study demonstrated a significant reduction of the composite primary endpoint of cardiovascular death, MI and stroke in the ticagrelor group. This is a practice-changing study with ticagrelor recently replacing clopidogrel in our code STEMI protocol but as a group we identified that the drug is significantly underutilized in cases of NSTEMI and UA, perhaps due to cost.
By: Dr. Tamara McColl
(Presented February 2013)

Epi Lesson – Survival Analyses
Survival analyses are used in clinical trials that follow patients over time for primary outcomes such as death, relapse, adverse drug reaction, or development of a new disease. The follow-up time may range from hours to years and a different set of statistical procedures are employed to analyze the data. Terms frequently seen in papers with survival analyses include Cox proportional hazard model, hazard ratio, Kaplan-Meir curve. 
By: Dr. Ian Stiell

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