EUCLID

Examining Use of Ticagrelor in Symptomatic Peripheral Artery Disease

Patient / Population Intervention / Exposure Comparison Outcome

In 13,885 patients with symptomatic peripheral artery disease, ticagrelor monotherapy did not reduce cardiovascular death, myocardial infarction or ischaemic stroke compared with clopidogrel monotherapy.

13,885

Design

Double-blind, event-driven RCT

Endpoint

Composite of CV death, MI or ischaemic stroke

Relevance

Result10.8 % vs 10.6 % over a median 30 months (HR 1.02; 95 % CI 0.92–1.13; p=0.65). Acute limb ischaemia and major bleeding 1.7 % and 1.6 % in both arms.

Hiatt WR, Fowkes FG, et al. N Engl J Med. 2017;376(1):32-40. 10.1056/NEJMoa1611688

Discussion & critique

A clean, fully powered null result with no aspirin arm, so it cannot address antiplatelet choice beyond the two drugs tested. Its value is negative evidence: escalating single-antiplatelet potency buys nothing in PAD, and clopidogrel remains the reference monotherapy.