Ticagrelor use was associated with higher bleeding risk compared with clopidogrel in individuals with ACS. The study, published in JACC: Asia, evaluated bleeding outcomes in a nationwide Singapore cohort using a propensity-matched design.

A retrospective cohort analysis identified 14,812 adults with ACS who underwent coronary revascularization between 2013 and 2017. Of these, 8,502 (57%) received clopidogrel and 6,310 (43%) received ticagrelor, with a median follow-up of 12 months. Ticagrelor use was associated with higher clinically relevant bleeding (adjusted hazard ratio (HR) 1.20; 95% confidence interval (CI) 1.02–1.40). The excess risk was most evident for Bleeding Academic Research Consortium (BARC) type 3 bleeding (adjusted HR 1.33; 95% CI 1.04–1.69).

Of these, 8,502 (57%) received clopidogrel and 6,310 (43%) received ticagrelor, with a median follow-up of 12 months. Ticagrelor use was associated with higher 1-year clinically relevant bleeding, with an adjusted hazard ratio (HR) of 1.20 (95% CI 1.02–1.40; P = 0.022). The higher risk was most evident for Bleeding Academic Research Consortium (BARC) type 3 bleeding (adjusted HR 1.33; 95% CI 1.04–1.69).

Independent bleeding predictors included age ≥65 years, higher comorbidity burden, COPD, hyperlipidemia, severe CKD chronic kidney disease, anemia, prior bleeding within 6 months, and concurrent oral anticoagulant use. Bleeding odds varied across ethnic groups: Indian and “other” patients groups had lower bleeding risk compared to with Chinese individuals, while Malays and Chinese had similar risk profile.

The findings indicate substantial bleeding risk differences across P2Y12 inhibitors and ethnic subgroups, supporting the need for prospective validation.