Table 2 Open in new tab Most important...

Study	Publication year	Size	Follow-up	Treatment and comparator	Primary endpoint	Outcome
Major studies comparing antiplatelet agents in acute coronary syndromes
ISIS-2¹⁰⁶	1988	17 187	5 weeks	Aspirin vs. placebo	Vascular mortality at 5 weeks	23% odds reduction
CURE¹¹⁰	2001	12 562	12 months	Aspirin + clopidogrel vs. aspirin + placebo	CV death, non-fatal MI, or stroke	9.3% vs. 11.4%; RR 0.80 (0.72–0.90)
COMMIT¹⁰⁹	2005	45 852	4 weeks	Aspirin + clopidogrel vs. aspirin + placebo	Death, re-infarction, or stroke	9.2% vs. 10.1%: RR 0.91 (0.86–0.97)
CLARITY-TIMI 28¹¹³	2005	3491	30 days	Aspirin + clopidogrel vs. aspirin + placebo	Failed reperfusion or reocclusion, death from any cause	15% vs. 21.7%; OR 0.64 (0.53–0.76)
TRITON-TIMI 38¹¹²	2007	13 608	1 year	Aspirin + prasugrel vs. aspirin + clopidogrel	CV death, non-fatal MI, or stroke	9.9% vs. 12.1%; HR 0.81 (0.73–0.90)
PLATO¹¹⁴	2009	18 624	1 year	Aspirin + ticagrelor vs. aspirin + clopidogrel	CV death, MI stroke	9.8% vs. 11.7%; HR 0.84 (0.77–0.92)
ISAR-REACT 5¹¹¹	2019	4018	1 year	Aspirin + ticagrelor vs. aspirin + prasugrel	Death, MI, stroke	9.3% vs. 6.9%; HR 1.36 (1.09–1.70)
Major studies comparing antiplatelet strategies in either chronic or acute coronary syndromes
PEGASUS-TIMI 54¹¹⁵	2017	21 162	33 months	Aspirin + ticagrelor 90 mg, aspirin + ticagrelor 60 mg, aspirin + placebo	CV death, MI, stroke TIMI major bleed	Ticagrelor 60 mg HR 0.79 (0.62–1.00) Bleed HR 1.65
DAPT¹⁰⁸	2014	9961	30 months	After 12 months DAPT, aspirin + P2Y₁₂ vs. aspirin + placebo for further 18 months	Death, MI, stroke, ST	4.3% vs. 5.9% for MACE: HR 0.71 (0.59–0.85) 0.4% vs. 1.4% for ST: HR 0.29 (0.17–0.48) Bleed 2.5% vs. 1.6%
TROPICAL-ACS¹¹⁶	2017	2610	1 year	Aspirin + prasugrel vs. aspirin + prasugrel 1 week then PFT guided clopidogrel	CV death, MI, stroke, BARC 2, or greater bleeding	9% vs. 7%; HR 0.81 (0.62–1.06)
GLOBAL LEADERS¹¹⁷	2018	15 968	2 years	Aspirin + ticagrelor 1 month, then ticagrelor 23 months vs. aspirin + P2Y₁₂ for 12 months, then aspirin monotherapy	All-cause death, non-fatal MI	3.81% vs. 4.37%; rate ratio 0.87 (0.75–1.01)

Study

Publication year

Size

Follow-up

Treatment and comparator

Primary endpoint

Outcome

Major studies comparing antiplatelet agents in acute coronary syndromes

ISIS-2¹⁰⁶

1988

17 187

5 weeks

Aspirin vs. placebo

Vascular mortality at 5 weeks

23% odds reduction

CURE¹¹⁰

2001

12 562

12 months

Aspirin + clopidogrel vs. aspirin + placebo

CV death, non-fatal MI, or stroke

9.3% vs. 11.4%; RR 0.80 (0.72–0.90)

COMMIT¹⁰⁹

2005

45 852

4 weeks

Aspirin + clopidogrel vs. aspirin + placebo

Death, re-infarction, or stroke

9.2% vs. 10.1%: RR 0.91 (0.86–0.97)

CLARITY-TIMI 28¹¹³

2005

3491

30 days

Aspirin + clopidogrel vs. aspirin + placebo

Failed reperfusion or reocclusion, death from any cause

15% vs. 21.7%; OR 0.64 (0.53–0.76)

TRITON-TIMI 38¹¹²

2007

13 608

1 year

Aspirin + prasugrel vs. aspirin + clopidogrel

CV death, non-fatal MI, or stroke

9.9% vs. 12.1%; HR 0.81 (0.73–0.90)

PLATO¹¹⁴

2009

18 624

1 year

Aspirin + ticagrelor vs. aspirin + clopidogrel

CV death, MI stroke

9.8% vs. 11.7%; HR 0.84 (0.77–0.92)

ISAR-REACT 5¹¹¹

2019

4018

1 year

Aspirin + ticagrelor vs. aspirin + prasugrel

Death, MI, stroke

9.3% vs. 6.9%; HR 1.36 (1.09–1.70)

Major studies comparing antiplatelet strategies in either chronic or acute coronary syndromes

PEGASUS-TIMI 54¹¹⁵

2017

21 162

33 months

Aspirin + ticagrelor 90 mg, aspirin + ticagrelor 60 mg, aspirin + placebo

CV death, MI, stroke
TIMI major bleed

Ticagrelor 60 mg HR 0.79 (0.62–1.00)
Bleed HR 1.65

DAPT¹⁰⁸

2014

9961

30 months

After 12 months DAPT, aspirin + P2Y₁₂ vs. aspirin + placebo for further 18 months

Death, MI, stroke, ST

4.3% vs. 5.9% for MACE: HR 0.71 (0.59–0.85)
0.4% vs. 1.4% for ST: HR 0.29 (0.17–0.48)
Bleed 2.5% vs. 1.6%

TROPICAL-ACS¹¹⁶

2017

2610

1 year

Aspirin + prasugrel vs. aspirin + prasugrel 1 week then PFT guided clopidogrel

CV death, MI, stroke, BARC 2, or greater bleeding

9% vs. 7%; HR 0.81 (0.62–1.06)

GLOBAL LEADERS¹¹⁷

2018

15 968

2 years

Aspirin + ticagrelor 1 month, then ticagrelor 23 months vs. aspirin + P2Y₁₂ for 12 months, then aspirin monotherapy

All-cause death, non-fatal MI

3.81% vs. 4.37%; rate ratio 0.87 (0.75–1.01)

Study	Publication year	Size	Follow-up	Treatment and comparator	Primary endpoint	Outcome
Major studies comparing antiplatelet agents in acute coronary syndromes
ISIS-2¹⁰⁶	1988	17 187	5 weeks	Aspirin vs. placebo	Vascular mortality at 5 weeks	23% odds reduction
CURE¹¹⁰	2001	12 562	12 months	Aspirin + clopidogrel vs. aspirin + placebo	CV death, non-fatal MI, or stroke	9.3% vs. 11.4%; RR 0.80 (0.72–0.90)
COMMIT¹⁰⁹	2005	45 852	4 weeks	Aspirin + clopidogrel vs. aspirin + placebo	Death, re-infarction, or stroke	9.2% vs. 10.1%: RR 0.91 (0.86–0.97)
CLARITY-TIMI 28¹¹³	2005	3491	30 days	Aspirin + clopidogrel vs. aspirin + placebo	Failed reperfusion or reocclusion, death from any cause	15% vs. 21.7%; OR 0.64 (0.53–0.76)
TRITON-TIMI 38¹¹²	2007	13 608	1 year	Aspirin + prasugrel vs. aspirin + clopidogrel	CV death, non-fatal MI, or stroke	9.9% vs. 12.1%; HR 0.81 (0.73–0.90)
PLATO¹¹⁴	2009	18 624	1 year	Aspirin + ticagrelor vs. aspirin + clopidogrel	CV death, MI stroke	9.8% vs. 11.7%; HR 0.84 (0.77–0.92)
ISAR-REACT 5¹¹¹	2019	4018	1 year	Aspirin + ticagrelor vs. aspirin + prasugrel	Death, MI, stroke	9.3% vs. 6.9%; HR 1.36 (1.09–1.70)
Major studies comparing antiplatelet strategies in either chronic or acute coronary syndromes
PEGASUS-TIMI 54¹¹⁵	2017	21 162	33 months	Aspirin + ticagrelor 90 mg, aspirin + ticagrelor 60 mg, aspirin + placebo	CV death, MI, stroke TIMI major bleed	Ticagrelor 60 mg HR 0.79 (0.62–1.00) Bleed HR 1.65
DAPT¹⁰⁸	2014	9961	30 months	After 12 months DAPT, aspirin + P2Y₁₂ vs. aspirin + placebo for further 18 months	Death, MI, stroke, ST	4.3% vs. 5.9% for MACE: HR 0.71 (0.59–0.85) 0.4% vs. 1.4% for ST: HR 0.29 (0.17–0.48) Bleed 2.5% vs. 1.6%
TROPICAL-ACS¹¹⁶	2017	2610	1 year	Aspirin + prasugrel vs. aspirin + prasugrel 1 week then PFT guided clopidogrel	CV death, MI, stroke, BARC 2, or greater bleeding	9% vs. 7%; HR 0.81 (0.62–1.06)
GLOBAL LEADERS¹¹⁷	2018	15 968	2 years	Aspirin + ticagrelor 1 month, then ticagrelor 23 months vs. aspirin + P2Y₁₂ for 12 months, then aspirin monotherapy	All-cause death, non-fatal MI	3.81% vs. 4.37%; rate ratio 0.87 (0.75–1.01)

Table 2

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Most important randomized clinical trials on antiplatelet therapy in patients with chronic or acute coronary syndromes

Study	Publication year	Size	Follow-up	Treatment and comparator	Primary endpoint	Outcome
Major studies comparing antiplatelet agents in acute coronary syndromes
ISIS-2¹⁰⁶	1988	17 187	5 weeks	Aspirin vs. placebo	Vascular mortality at 5 weeks	23% odds reduction
CURE¹¹⁰	2001	12 562	12 months	Aspirin + clopidogrel vs. aspirin + placebo	CV death, non-fatal MI, or stroke	9.3% vs. 11.4%; RR 0.80 (0.72–0.90)
COMMIT¹⁰⁹	2005	45 852	4 weeks	Aspirin + clopidogrel vs. aspirin + placebo	Death, re-infarction, or stroke	9.2% vs. 10.1%: RR 0.91 (0.86–0.97)
CLARITY-TIMI 28¹¹³	2005	3491	30 days	Aspirin + clopidogrel vs. aspirin + placebo	Failed reperfusion or reocclusion, death from any cause	15% vs. 21.7%; OR 0.64 (0.53–0.76)
TRITON-TIMI 38¹¹²	2007	13 608	1 year	Aspirin + prasugrel vs. aspirin + clopidogrel	CV death, non-fatal MI, or stroke	9.9% vs. 12.1%; HR 0.81 (0.73–0.90)
PLATO¹¹⁴	2009	18 624	1 year	Aspirin + ticagrelor vs. aspirin + clopidogrel	CV death, MI stroke	9.8% vs. 11.7%; HR 0.84 (0.77–0.92)
ISAR-REACT 5¹¹¹	2019	4018	1 year	Aspirin + ticagrelor vs. aspirin + prasugrel	Death, MI, stroke	9.3% vs. 6.9%; HR 1.36 (1.09–1.70)
Major studies comparing antiplatelet strategies in either chronic or acute coronary syndromes
PEGASUS-TIMI 54¹¹⁵	2017	21 162	33 months	Aspirin + ticagrelor 90 mg, aspirin + ticagrelor 60 mg, aspirin + placebo	CV death, MI, stroke TIMI major bleed	Ticagrelor 60 mg HR 0.79 (0.62–1.00) Bleed HR 1.65
DAPT¹⁰⁸	2014	9961	30 months	After 12 months DAPT, aspirin + P2Y₁₂ vs. aspirin + placebo for further 18 months	Death, MI, stroke, ST	4.3% vs. 5.9% for MACE: HR 0.71 (0.59–0.85) 0.4% vs. 1.4% for ST: HR 0.29 (0.17–0.48) Bleed 2.5% vs. 1.6%
TROPICAL-ACS¹¹⁶	2017	2610	1 year	Aspirin + prasugrel vs. aspirin + prasugrel 1 week then PFT guided clopidogrel	CV death, MI, stroke, BARC 2, or greater bleeding	9% vs. 7%; HR 0.81 (0.62–1.06)
GLOBAL LEADERS¹¹⁷	2018	15 968	2 years	Aspirin + ticagrelor 1 month, then ticagrelor 23 months vs. aspirin + P2Y₁₂ for 12 months, then aspirin monotherapy	All-cause death, non-fatal MI	3.81% vs. 4.37%; rate ratio 0.87 (0.75–1.01)

Study	Publication year	Size	Follow-up	Treatment and comparator	Primary endpoint	Outcome
Major studies comparing antiplatelet agents in acute coronary syndromes
ISIS-2¹⁰⁶	1988	17 187	5 weeks	Aspirin vs. placebo	Vascular mortality at 5 weeks	23% odds reduction
CURE¹¹⁰	2001	12 562	12 months	Aspirin + clopidogrel vs. aspirin + placebo	CV death, non-fatal MI, or stroke	9.3% vs. 11.4%; RR 0.80 (0.72–0.90)
COMMIT¹⁰⁹	2005	45 852	4 weeks	Aspirin + clopidogrel vs. aspirin + placebo	Death, re-infarction, or stroke	9.2% vs. 10.1%: RR 0.91 (0.86–0.97)
CLARITY-TIMI 28¹¹³	2005	3491	30 days	Aspirin + clopidogrel vs. aspirin + placebo	Failed reperfusion or reocclusion, death from any cause	15% vs. 21.7%; OR 0.64 (0.53–0.76)
TRITON-TIMI 38¹¹²	2007	13 608	1 year	Aspirin + prasugrel vs. aspirin + clopidogrel	CV death, non-fatal MI, or stroke	9.9% vs. 12.1%; HR 0.81 (0.73–0.90)
PLATO¹¹⁴	2009	18 624	1 year	Aspirin + ticagrelor vs. aspirin + clopidogrel	CV death, MI stroke	9.8% vs. 11.7%; HR 0.84 (0.77–0.92)
ISAR-REACT 5¹¹¹	2019	4018	1 year	Aspirin + ticagrelor vs. aspirin + prasugrel	Death, MI, stroke	9.3% vs. 6.9%; HR 1.36 (1.09–1.70)
Major studies comparing antiplatelet strategies in either chronic or acute coronary syndromes
PEGASUS-TIMI 54¹¹⁵	2017	21 162	33 months	Aspirin + ticagrelor 90 mg, aspirin + ticagrelor 60 mg, aspirin + placebo	CV death, MI, stroke TIMI major bleed	Ticagrelor 60 mg HR 0.79 (0.62–1.00) Bleed HR 1.65
DAPT¹⁰⁸	2014	9961	30 months	After 12 months DAPT, aspirin + P2Y₁₂ vs. aspirin + placebo for further 18 months	Death, MI, stroke, ST	4.3% vs. 5.9% for MACE: HR 0.71 (0.59–0.85) 0.4% vs. 1.4% for ST: HR 0.29 (0.17–0.48) Bleed 2.5% vs. 1.6%
TROPICAL-ACS¹¹⁶	2017	2610	1 year	Aspirin + prasugrel vs. aspirin + prasugrel 1 week then PFT guided clopidogrel	CV death, MI, stroke, BARC 2, or greater bleeding	9% vs. 7%; HR 0.81 (0.62–1.06)
GLOBAL LEADERS¹¹⁷	2018	15 968	2 years	Aspirin + ticagrelor 1 month, then ticagrelor 23 months vs. aspirin + P2Y₁₂ for 12 months, then aspirin monotherapy	All-cause death, non-fatal MI	3.81% vs. 4.37%; rate ratio 0.87 (0.75–1.01)

BARC, Bleeding Academic Research Consortium; CV, cardiovascular; DAPT, dual antiplatelet therapy; HR, hazard ratio; MACE, major adverse cardiovascular events; MI, myocardial infarction; OR, odds ratio; PFT, platelet function testing; RR, relative risk; ST, stent thrombosis; TIMI, Thrombolysis in Myocardial Infarction.

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