PLATO

About the Trial

The Platelet Inhibition and Patient Outcomes trial randomized 18,624 acute coronary syndrome patients to ticagrelor or clopidogrel for 12 months. Ticagrelor reduced cardiovascular death, heart attack, or stroke by 16 percent, including all cause mortality by 22 percent, without more major bleeding overall. Faster, more potent, and reversible P2Y12 inhibition improved outcomes. A puzzling North American subgroup interaction triggered extensive reanalysis that never fully resolved. PLATO led to wide use of ticagrelor in high risk acute coronary syndromes and reinforced that clopidogrel, a prodrug with variable metabolism, left room for improvement. TWILIGHT later found that ticagrelor monotherapy after 3 months of dual therapy reduced bleeding without an observed rise in ischemic events.