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The effect of ticagrelor on growth of small abdominal aortic aneurysms-a randomized controlled trial

Artikel i vetenskaplig tidskrift
Författare A. Wanhainen
K. Mani
J. Kullberg
S. Svensjo
A. Bersztel
L. Karlsson
J. Holst
A. Gottsater
A. Linne
P. Gillgren
Marcus Langenskiöld
R. Hultgren
J. Roy
N. P. Gilgen
H. Ahlstrom
F. A. Lederle
M. Bjorck
Publicerad i Cardiovascular Research
Volym 116
Nummer/häfte 2
Sidor 450-456
ISSN 0008-6363
Publiceringsår 2020
Publicerad vid Institutionen för medicin, avdelningen för molekylär och klinisk medicin
Sidor 450-456
Språk en
Länkar dx.doi.org/10.1093/cvr/cvz133
Ämnesord Abdominal aortic aneurysm, Growth inhibitor, Intraluminal thrombus, Ticagrelor, Anti-platelet treatment, Randomized controlled trial, Aortic, volume, Aortic diameter, bleeding, acute coronary syndromes, intraluminal thrombus, mural thrombus, double-blind, steady flow, volume, clopidogrel, Cardiovascular System & Cardiology
Ämneskategorier Kardiologi

Sammanfattning

Aims: To evaluate if ticagrelor, an effective platelet inhibitor without known non-responders, could inhibit growth of small abdominal aortic aneurysms (AAAs). Methods and results: In this multi-centre randomized controlled trial, double-blinded for ticagrelor and placebo, acetylic salicylic acid naive patients with AAA and with a maximum aortic diameter 35-49mm were included. The primary outcome was mean reduction in log-transformed AAA volume growth rate (%) measured with magnetic resonance imaging (MRI) at 12months compared with baseline. Secondary outcomes include AAA-diameter growth rate and intraluminal thrombus (ILT) volume enlargement rate. A total of 144 patients from eight Swedish centres were randomized (72 in each group). MRI AAA volume increase was 9.1% for the ticagrelor group and 7.5% for the placebo group (P=0.205) based on intention-to-treat analysis, and 8.5% vs. 7.4% in a per-protocol analysis (P=0.372). MRI diameter change was 2.5mm vs. 1.8mm (P=0.113), US diameter change 2.3mm vs. 2.2mm (P=0.778), and ILT volume change 12.9% vs. 10.4% (P=0.590). Conclusion: In this RCT, platelet inhibition with ticagrelor did not reduce growth of small AAAs. Whether the ILT has an important pathophysiological role for AAA growth cannot be determined based on this study due to the observed lack of thrombus modulating effect of ticagrelor.

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