Eligibility |
Please see: https://drive.google.com/drive/folders/1WD618wrywYjEaXzfLTcuK-VCcnb6b-gV for
full code and algorithm definitions.
Market availability of ticagrelor in the U.S. started on 2011-07-20.
- For Marketscan: 2011-07-20 to 2017-12-31 (end of data availability).
- For Optum: 2011-07-20 to 2019-03-31 (end of data availability).
Inclusion Criteria:
- 1-4 ALL REQUIRED
- 1. Hospitalized for potential ST-segment elevation or non-ST-segment elevation
ACS, with onset during the previous 24 hours, documented by cardiac ischemic
symptoms due to atherosclerosis of =10 minutes' duration at rest
- 2. =18 years of age
- 3. Not pregnant. Urinary and/or blood pregnancy tests are to be performed in
women of child-bearing potential and repeated at least every 6 months. Women of
child-bearing potential must be using =2 forms of reliable contraception,
including one barrier method.
- 4. With informed consent 1-4 AND 5A OR 5B
- 5A. =2 of the following:
- 1. ST-segment changes on ECG indicating ischemia. ST-segment depression or
transient elevation = 1 mm in two or more 2 contiguous leads"
- 2. Positive biomarker indicating myocardial necrosis. Troponin I or T or CK-MB
greater than the upper limit of normal
- 3. One of the following:
1. =60 y of age
2. Previous MI or CABG
3. CAD with =50% stenosis in =2 vessels
4. Previous ischemic stroke, TIA (hospital-based diagnosis), carotid stenosis
(=50%), or cerebral revascularization
5. Diabetes mellitus
6. Peripheral artery disease
7. Chronic renal dysfunction
- OR
- 5B. Persistent ST-segment elevation =1 mm (not known to be preexisting or due to a
coexisting disorder) in =2 contiguous leads or new LBBB plus primary PCI planned.
Exclusion Criteria:
- Drug related
- 1. Contraindication to clopidogrel or other reason that study drug should not be
administered (eg, hypersensitivity, moderate or severe liver disease, active
bleeding or bleeding history, major surgery within 30 days)"
- 2. Oral anticoagulation therapy that cannot be stopped
- 3. Fibrinolytic therapy planned or within the previous 24 h
- 4. Concomitant oral or IV therapy with strong CYP3A inhibitors (ketoconazole,
itraconazole, voriconazole, telithromycin, clarithromycin, nefazodone, ritonavir,
saquinavir, nelfinavir, indinavir, atazanavir, grapefruit juice N1 L/d), CYP3A
substrates with narrow therapeutic indices (cyclosporine, quinidine), or strong
CYP3A inducers (rifampin/rifampicin, phenytoin, carbamazepine)
- Treatment related
- 1. Index event is an acute complication of PCI
- 2. PCI after index event and before first study dose
- Medical
- 1. Increased risk of bradycardiac events
- 2. Dialysis required
- 3. Known clinically important thrombocytopenia
- 4. Known clinically important anemia
- 5. Any other condition that may put the patient at risk or influence study
results in the investigators' opinion (eg, cardiogenic shock, severe hemodynamic
instability, active cancer)
- General
- 1. Participant in another investigational drug or device study within 30 days
- 2. Pregnancy or lactation
- 3. Any condition that increases the risk for noncompliance or being lost to
follow-up
- 4. Involvement in the planning or conduct of the study
- 5. Previous enrollment or randomization in this study
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