CLINICAL EFFECTIVENESS AND SAFETY OF ASPIRIN WITH CLOPIDOGREL VERSUS TICAGRELOR IN ACUTE CORONARY SYNDROME: A RETROSPECTIVE OBSERVATIONAL STUDY
Main Article Content
Keywords
Acute Coronary Syndrome, DAPT Aspirin, Clopidogrel, Ticagrelor
Abstract
Background: Dual antiplatelet therapy (DAPT), combining aspirin with a P2Y12 inhibitor, is central to acute coronary syndrome (ACS) management. While ticagrelor provides enhanced platelet inhibition, concerns remain regarding bleeding risk, tolerability, and adherence. Real-world comparative data of high-dose aspirin + clopidogrel versus standard-dose aspirin + ticagrelor are limited in Indian populations.
Objective: To evaluate the clinical effectiveness, safety profile, and patient-reported outcomes of aspirin-based DAPT in ACS patients, comparing aspirin 150 mg + clopidogrel 75 mg with aspirin 75 mg + ticagrelor 90 mg.
Methods: A retrospective observational study was conducted over six months at a tertiary care hospital in India, including 130 ACS patients (STEMI, NSTEMI, UA). Patients were divided into two DAPT groups. Clinical outcomes were assessed via symptom relief, bleeding events (BARC criteria), gastrointestinal side effects, medication adherence, and patient satisfaction. Statistical analyses included chi-square tests, Z-tests, and t-tests, with significance set at p < 0.05.
Results: Baseline demographics, ACS subtype distribution, and cardiac function were comparable. Symptom relief was high in both groups (96% in clopidogrel vs. 92% in ticagrelor; p < 0.001). Bleeding events were more frequent in the ticagrelor group (30% vs. 6.4%; p < 0.001), including more major bleeds (10% vs. 1.3%). Gastrointestinal side effects were higher with ticagrelor (24% vs. 5.1%; p = 0.004). Patient satisfaction (69% vs. 38%; p < 0.001) and adherence (85% vs. 60%; p = 0.008) were significantly better in the clopidogrel group. Both regimens provided effective symptom control and functional recovery.
Conclusion: Aspirin 150 mg + clopidogrel 75 mg demonstrated superior safety, tolerability, and adherence compared to aspirin 75 mg + ticagrelor 90 mg while maintaining comparable clinical effectiveness. Ticagrelor provides potent platelet inhibition but at higher bleeding risk. Therapy selection should be individualized based on ischemic and bleeding risk, adherence potential, and socioeconomic factors. These findings support both regimens’ continued use in real-world Indian ACS populations.
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Mahavarkar Swarali D
Dept. of Pharmacy Practice, Channabasweshwar Pharmacy College (Degree), Near Basweshwar Chowk, Kava Road, Latur-41312, Maharashtra
Jadhav Pranita D
Dept. of Pharmacy Practice, Channabasweshwar Pharmacy College (Degree), Near Basweshwar Chowk, Kava Road, Latur-41312, Maharashtra
Suryawanshi Pratiksha D
Dept. of Pharmacy Practice, Channabasweshwar Pharmacy College (Degree), Near Basweshwar Chowk, Kava Road, Latur-41312, Maharashtra
Patne Anamika S
Dept. of Pharmacy Practice, Channabasweshwar Pharmacy College (Degree), Near Basweshwar Chowk, Kava Road, Latur-41312, Maharashtra
Shivakumar S. Ladde
Head, Dept. of Pharmacy Practice Channabasweshwar Pharmacy College (Degree), Latur, Maharashtra, India