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The effect of ticagrelor on growth of small abdominal aortic aneurysms: a randomized controlled trial
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.ORCID iD: 0000-0002-3273-8726
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.ORCID iD: 0000-0002-4224-5351
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Radiology. Antaros Medical.ORCID iD: 0000-0001-8205-7569
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery. Falun County Hospital.ORCID iD: 0000-0002-5616-8393
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2020 (English)In: Cardiovascular Research, ISSN 0008-6363, E-ISSN 1755-3245, Vol. 116, no 2, p. 450-456Article in journal (Refereed) Published
Abstract [en]

AIM: To evaluate if ticagrelor, an effective platelet inhibitor without known non-responders, could inhibit growth of small AAAs.

METHODS AND RESULTS: In this multi-center randomized controlled trial, double-blinded for ticagrelor and placebo, acetylic salicylic acid naïve patients with AAA and with a maximum aortic diameter 35-49 mm were included. The primary outcome was mean reduction in log-transformed AAA volume growth rate (%) measured with magnetic resonance imaging (MRI) at 12 months compared with baseline. Secondary outcomes include AAA-diameter growth rate and ILT volume enlargement rate. 144 patients from eight Swedish centers 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 2.5 mm vs 1.8 mm (p = 0.113), US diameter change 2.3 mm vs 2.2 mm (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.

Place, publisher, year, edition, pages
2020. Vol. 116, no 2, p. 450-456
Keywords [en]
Abdominal aortic aneurysm, Growth inhibitor, Intraluminal thrombus, Ticagrelor, Anti-platelet treatment, Randomized controlled trial, Aortic volume, Aortic diameter, bleeding
National Category
Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:uu:diva-392825DOI: 10.1093/cvr/cvz133ISI: 000515095600028PubMedID: 31135888OAI: oai:DiVA.org:uu-392825DiVA, id: diva2:1349954
Funder
AstraZenecaAvailable from: 2019-09-10 Created: 2019-09-10 Last updated: 2020-03-30Bibliographically approved

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Wanhainen, AndersMani, KevinKullberg, JoelSvensjö, SverkerBersztel, AdamKarlsson, LarsAhlström, HåkanBjörck, Martin

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