Brilinta Decreases Stroke Risk, But Increases Bleeding, In Some Patients When Compared To Plavix: Study

Treating stroke patients with a combination of Brilinta and aspirin can reduce their risk of future strokes when compared to Plavix, but may also increase the risk of bleeding problems, according to the findings of a new study.

Chinese researchers found that Brilinta helped to reduce the risk of repeat stroke among patients with a specific gene expression, known as CYP2C19 loss-of-function carriers. However, it was also linked to an increased bleeding risk.

The findings were published December 30, in the New England Journal of Medicine.

Cytochrome P450 2C19 (CYP2C19) is an enzyme protein involved in the metabolism of more than 10 commonly prescribed drugs. Among patients taking clotting drugs like Plavix, this enzyme breaks it down and prevents the formation of blood clots and does not allow the medication to work properly.

Brilinta (ticagrelor) is a blood thinner used to reduce the risk of cardiovascular death, heart attacks and strokes in patients with acute coronary syndrome (ACS), or by those with history of heart attacks. Brilinta is also commonly used to reduce the rate of stent thrombosis in patients who have received stents for treatment of ACS.

Using Plavix (clopidogrel) or Brilinta to prevent stroke in CYP2C19 loss-of-function gene carriers has not been extensively studied. So, the researchers focused on this sub-group of patients at risk of suffering a second stroke by conducting a randomized double-blind placebo-controlled trial at 202 centers in China, involving patients with a minor ischemic stroke or transient ischemic attack.

Overall, 6,400 patients were assigned to either the Brilinta or Plavix group. Half of patients were given 180 mg of Brilinta on day 1 followed by 90 mg twice daily on days 2 through 90. The other half of patients were either given 300 mg of Plavix on day 1 followed by 75 mg once daily on days 2 through 90. All patients were also given aspirin for 21 days.

Patients taking Brilinta had a lower risk of suffering a repeat stroke within 90 days compared to patients taking Plavix. Roughly 6% of patients taking Brilinta suffered a stroke within 90 days of starting the medication compared to 8% of patients in the Plavix group.

Participants in both groups suffered moderate bleeding, 0.3% in both the Plavix and Brilliant group had severe or moderate bleeding occur. However, 5.3% of the Brilinta group suffered some type of bleeding event, compared to only 2.5% of the Plavix group.

The researchers concluded taking Brilinta provides these gene-carrier patients decreased risk of suffering stroke or death once they start the combination aspirin treatment. Patients suffered fewer major ischemic events but had an increased risk of hemorrhage.

“Among Chinese patients with minor ischemic stroke or transient ischemic stroke who were carriers of CYP2C19 loss-of-function alleles, the risk of stroke at 90 days was modestly lower with ticagrelor than with clopidogrel,” the researchers wrote. “The risk of severe or moderate bleeding did not differ between the two treatment groups, but ticagrelor was associated with more total bleeding events than clopidogrel.”

Another study published in 2020 echoes the results of this new study. Researchers with the University of Texas found that Brilinta with aspirin lowered the risk of stroke, but increased the risk of severe bleeding overall.

Other studies have indicated taking Brillinta with aspirin did not reduce the risk of stroke, but instead increased the risk of serious bleeding. Another study published in 2016 indicated patients taking Brillinta before heart surgery faced an increased risk of up to 20% for bleeding events.