Infections Deaths in the PLATO Trial

Background Cardiovascular benefits of aggressive dual antiplatelet therapy may be associated with extra risks including bleeding, cancer, and infections discovered first for prasugrel in the TRial to assess Improvement in Therapeutic Outcomes by optimizing platelet InhibitioN with prasugrel (TRITON)...

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Autores principales:	Victor Serebruany, Jean-Francois Tanguay
Formato:	article
Lenguaje:	EN
Publicado:	Georg Thieme Verlag KG 2021
Materias:	clinical trial ticagrelor clopidogrel death infections pneumonia sepsis Diseases of the circulatory (Cardiovascular) system RC666-701
Acceso en línea:	https://doaj.org/article/21f0efbfbda84e639dc973214dd37e3d
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spelling	oai:doaj.org-article:21f0efbfbda84e639dc973214dd37e3d2021-11-09T00:00:40ZInfections Deaths in the PLATO Trial2512-946510.1055/s-0041-1736638https://doaj.org/article/21f0efbfbda84e639dc973214dd37e3d2021-10-01T00:00:00Zhttp://www.thieme-connect.de/DOI/DOI?10.1055/s-0041-1736638https://doaj.org/toc/2512-9465Background Cardiovascular benefits of aggressive dual antiplatelet therapy may be associated with extra risks including bleeding, cancer, and infections discovered first for prasugrel in the TRial to assess Improvement in Therapeutic Outcomes by optimizing platelet InhibitioN with prasugrel (TRITON) trial. Ticagrelor in PLATO also caused slightly more infections but surprisingly less sepsis-related deaths (SRD) than clopidogrel. However, verified infection fatalities in PLATO were lacking from the public domain. We obtained the complete Food and Drug Administration (FDA)-issued primary causes death list, matched it with the few local site records dataset and analyzed the patterns of infections and deaths reported in PLATO. Methods Among infections, the FDA spreadsheet contains only two primary death codes for pneumonia (12–2) and SRD (12–8). We obtained local evidence for two pneumonia and two SRD and matched those with the FDA records. We assessed how SRD patterns were reported among nonvascular death's dataset. Results The FDA PLATO records indicate that clopidogrel caused numerically less (n = 8) primary pneumonia deaths than ticagrelor (n = 10) but over three times more SRD (n = 23/7). Among matched verifiable outcomes, both pneumonia deaths were correct, but two clopidogrel SRD were incorrect. Of the remaining 21 clopidogrel SRD, 6 were reported as two separate closed paired entries in Brazil (lines 76 and 78 and 86 and 88) and India (lines 436 and 440), suggesting last minute addition of potentially incorrect SRD reports. Four ticagrelor SRD (lines 24,193,467 and 650) were “compensated” with close or next in line clopidogrel SRD entries (lines 22,195,468 and 651). Conclusion The FDA-issued evidence suggests no benefit of ticagrelor in preventing deaths from infections with slightly more pneumonia deaths, with possible misreporting of SRD in PLATO. These findings require an in-depth precise review of sepsis deaths in this trial.Victor SerebruanyJean-Francois TanguayGeorg Thieme Verlag KGarticleclinical trialticagrelorclopidogreldeathinfectionspneumoniasepsisDiseases of the circulatory (Cardiovascular) systemRC666-701ENTH Open, Vol 05, Iss 04, Pp e503-e506 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	clinical trial ticagrelor clopidogrel death infections pneumonia sepsis Diseases of the circulatory (Cardiovascular) system RC666-701
spellingShingle	clinical trial ticagrelor clopidogrel death infections pneumonia sepsis Diseases of the circulatory (Cardiovascular) system RC666-701 Victor Serebruany Jean-Francois Tanguay Infections Deaths in the PLATO Trial
description	Background Cardiovascular benefits of aggressive dual antiplatelet therapy may be associated with extra risks including bleeding, cancer, and infections discovered first for prasugrel in the TRial to assess Improvement in Therapeutic Outcomes by optimizing platelet InhibitioN with prasugrel (TRITON) trial. Ticagrelor in PLATO also caused slightly more infections but surprisingly less sepsis-related deaths (SRD) than clopidogrel. However, verified infection fatalities in PLATO were lacking from the public domain. We obtained the complete Food and Drug Administration (FDA)-issued primary causes death list, matched it with the few local site records dataset and analyzed the patterns of infections and deaths reported in PLATO. Methods Among infections, the FDA spreadsheet contains only two primary death codes for pneumonia (12–2) and SRD (12–8). We obtained local evidence for two pneumonia and two SRD and matched those with the FDA records. We assessed how SRD patterns were reported among nonvascular death's dataset. Results The FDA PLATO records indicate that clopidogrel caused numerically less (n = 8) primary pneumonia deaths than ticagrelor (n = 10) but over three times more SRD (n = 23/7). Among matched verifiable outcomes, both pneumonia deaths were correct, but two clopidogrel SRD were incorrect. Of the remaining 21 clopidogrel SRD, 6 were reported as two separate closed paired entries in Brazil (lines 76 and 78 and 86 and 88) and India (lines 436 and 440), suggesting last minute addition of potentially incorrect SRD reports. Four ticagrelor SRD (lines 24,193,467 and 650) were “compensated” with close or next in line clopidogrel SRD entries (lines 22,195,468 and 651). Conclusion The FDA-issued evidence suggests no benefit of ticagrelor in preventing deaths from infections with slightly more pneumonia deaths, with possible misreporting of SRD in PLATO. These findings require an in-depth precise review of sepsis deaths in this trial.
format	article
author	Victor Serebruany Jean-Francois Tanguay
author_facet	Victor Serebruany Jean-Francois Tanguay
author_sort	Victor Serebruany
title	Infections Deaths in the PLATO Trial
title_short	Infections Deaths in the PLATO Trial
title_full	Infections Deaths in the PLATO Trial
title_fullStr	Infections Deaths in the PLATO Trial
title_full_unstemmed	Infections Deaths in the PLATO Trial
title_sort	infections deaths in the plato trial
publisher	Georg Thieme Verlag KG
publishDate	2021
url	https://doaj.org/article/21f0efbfbda84e639dc973214dd37e3d
work_keys_str_mv	AT victorserebruany infectionsdeathsintheplatotrial AT jeanfrancoistanguay infectionsdeathsintheplatotrial
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Infections Deaths in the PLATO Trial

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