A comparison of cangrelor, prasugrel, ticagrelor, and clopidogrel in patients undergoing percutaneous coronary intervention: A network meta-analysis

Westman, Peter C.; Lipinski, Michael J.; Torguson, Rebecca; Waksman, Ron

doi:10.1016/j.carrev.2016.10.005

Cited by 29 publications

(11 citation statements)

References 68 publications

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“…The current study subclassified a total of 1898 MIs into NCL and CL reinfarctions. Improved stents, improved stenting techniques, and redefined antithrombotic treatment for the short‐term phase have had a substantial impact on stent‐related adverse outcomes, but perhaps this impact is less on overall disease progression and the risk of NCL‐related adverse outcomes . Mortality from coronary heart disease has decreased substantially in recent decades.…”

Section: Discussionmentioning

confidence: 99%

Culprit and Nonculprit Recurrent Ischemic Events in Patients With Myocardial Infarction: Data From SWEDEHEART (Swedish Web System for Enhancement and Development of Evidence‐Based Care in Heart Disease Evaluated According to Recommended Therapies)

Varenhorst

Hasvold

Johansson

et al. 2018

JAHA

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BackgroundLong‐term disease progression after myocardial infarction (MI) is inadequately understood. We evaluated the pattern and angiographic properties (culprit lesion [CL]/non‐CL [NCL]) of recurrent MI (re‐MI) in a large real‐world patient population.Methods and ResultsOur observational study used prospectively collected data in 108 615 patients with first‐occurrence MI enrolled in the SWEDEHEART (Swedish Web System for Enhancement and Development of Evidence‐Based Care in Heart Disease Evaluated According to Recommended Therapies) between July 1, 2006 and November 29, 2014. During follow‐up (median, 3.2 years), recurrent hospitalization for MI occurred in 11 117 patients (10.2%). Of the patients who underwent coronary angiography for the index MI, a CL was identified in 44 332 patients. Of those patients, 3464 experienced an re‐MI; the infarct originated from the NCL in 1243 patients and from the CL in 655 patients. In total, 1566 re‐MIs were indeterminate events and could not be classified as NCL or CL re‐MIs. The risk of re‐MI within 8 years related to the NCL was 0.06 (95% confidence interval [CI], 0.05–0.06), compared with 0.03 (95% CI, 0.02–0.03) for the CL. There were no large differences in baseline characteristics of patients with subsequent NCL versus CL re‐MIs. Independent predictors of NCL versus CL re‐ MI were multivessel disease (odds ratio, 2.29; 95% CI, 1.87–2.82), male sex (odds ratio, 1.36; 95% CI, 1.09–1.71), and a prolonged time between the index and re‐MI (odds ratio, 1.16; 95% CI, 1.10–1.22).ConclusionsIn a large cohort of patients with first‐occurrence MI undergoing percutaneous coronary intervention, the risk of re‐MI originating from a previously untreated lesion was twice higher than the risk of lesions originating from a previously stented lesion.Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT03099395.

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Section: Discussionmentioning

confidence: 99%

Culprit and Nonculprit Recurrent Ischemic Events in Patients With Myocardial Infarction: Data From SWEDEHEART (Swedish Web System for Enhancement and Development of Evidence‐Based Care in Heart Disease Evaluated According to Recommended Therapies)

Varenhorst

Hasvold

Johansson

et al. 2018

JAHA

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“…Moreover, the Rapid Activity of Platelet Inhibitor Drugs (RAPID) Primary PCI Study also showed non-inferiority of prasugrel with ticagrelor further supporting these current results [ 14 ]. A recent network meta-analysis comparing cangrelor, clopidogrel, ticagrelor and prasugrel post-intervention showed both ticagrelor and prasugrel to be comparable in terms of clinical outcomes [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

Head to head comparison of Prasugrel versus Ticagrelor in patients with acute coronary syndrome: a systematic review and meta-analysis of randomized trials

Bundhun

Shi

Huang

2017

BMC Pharmacol Toxicol

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BackgroundPrasugrel and Ticagrelor are emerging antiplatelet drugs that might have the potential to replace currently used antiplatelet agents. Previous analyses comparing prasugrel with ticagrelor mainly focused on an indirect comparison whereas direct comparison was reported only in a few recently published trials. We aimed to systematically carry out a head to head comparison of the adverse clinical outcomes which were associated with prasugrel versus ticagrelor in patients with acute coronary syndrome (ACS).MethodsStudies comparing prasugrel with ticagrelor (head to head comparison) were searched from online databases. Adverse cardiovascular outcomes were considered as the primary endpoints whereas bleeding outcomes were considered as the secondary endpoints in this analysis. The latest version of the RevMan software was used to carry out subgroup analyses whereby odds ratios (OR) with 95% confidence intervals (CI) and the calculated probability (P) were generated.ResultsFour studies with a total number of 563 patients (2012 – 2016) were included (282 patients were treated with prasugrel and 281 patients were treated with ticagrelor). Results of this analysis did not show any significant difference in mortality between prasugrel and ticagrelor with OR: 1.52, 95% CI: 0.42 – 5.45; P = 0.52. In addition, myocardial infarction, major adverse cardiac events, stroke and stent thrombosis were also not significantly different with OR: 0.59, 95% CI: 0.08 – 4.58; P = 0.62, OR: 0.91, 95% CI: 0.37 – 2.21; P = 0.83, OR: 0.60, 95% CI: 0.08 – 4.58; P = 0.62 and OR: 0.59, 95% CI: 0.08 – 4.58; P = 0.62 respectively.Thrombolysis in myocardial infarction (TIMI) defined minor bleeding, and minimal bleeding were also not significantly different between these two newer antiplatelet agents with OR: 3.11, 95% CI: 0.48 – 19.94; P = 0.23, and OR: 2.39, 95% CI: 0.35 – 16.42; P = 0.38 respectively. Moreover, bleeding defined by the academic research consortium was also similarly manifested with OR: 0.92, 95% CI: 0.39 – 2.13; P = 0.84.ConclusionIn patients with ACS, both prasugrel and ticagrelor showed similar adverse cardiovascular outcomes and bleeding events. No significant difference was observed between these two newer antiplatelet agents during this head to head comparison. However, upcoming trials with long term follow up periods might be expected to completely solve this important clinical issue.

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“…In continuation of aspirin, clopidogrel is now used widely in companion animals, with solid support from the veterinary literature particularly in cats. Novel antiplatelet agents, including novel P2Y 12 inhibitors (prasugrel, ticagrelor, and cangrelor) and the GPIIb/IIIa inhibitors (abciximab, tirofiban, and eptifibatide), may eventually be included in future iterations of these guidelines as these medications become more affordable. Progress is occurring in the use of anticoagulant therapies also.…”

Section: Resultsmentioning

confidence: 99%

Consensus on the Rational Use of Antithrombotics in Veterinary Critical Care (CURATIVE): Domain 3—Defining antithrombotic protocols

Blais

Bianco

Goggs

et al. 2019

J Vet Emergen Crit Care

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Objectives:To systematically examine the evidence for use of a specific protocol (dose, frequency, route) of selected antithrombotic drugs, in comparisons to no therapy or to other antithrombotic therapies, to reduce the risk of complications or improve outcomes in dogs and cats at risk for thrombosis. Design: Standardized, systematic evaluation of the literature, categorization of relevant articles according to level of evidence (LOE) and quality (Good, Fair, or Poor), and development of consensus on conclusions via a Delphi-style survey for application of the concepts to clinical practice. Settings: Academic and referral veterinary medical centers. Results: Databases searched included Medline via PubMed and CAB abstracts. Eight different antithrombotic drugs were investigated using a standardized Patient, Intervention, Comparison, Outcome (PICO) question format both for dogs and cats, including aspirin, clopidogrel, warfarin, unfractionated heparin (UFH), dalteparin, enoxaparin, fondaparinux, and rivaroxaban, generating a total of 16 worksheets. Most studies identified were experimental controlled laboratory studies in companion animals (LOE 3) with only four randomized controlled clinical trials in companion animals (LOE 1). Conclusions:Overall, evidence-based recommendations concerning specific protocols could not be formulated for most antithrombotic drugs evaluated, either because of the wide range of dosage reported (eg, aspirin in dogs) or the lack of evidence in the current literature. However, clopidogrel administration in dogs and cats at risk of arterial thrombosis, notably in cats at risk of cardiogenic thromboembolism, is supported by the literature, and specific protocols were recommended. Comparably, aspirin should not be used as a sole antithrombotic in cats with cardiomyopathy. Using the available safety profile information contained in the literature, the panel reached consensus on suggested dosage schemes for most antithrombotics. Significant knowledge gaps were highlighted, which will hopefully drive novel research.

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A comparison of cangrelor, prasugrel, ticagrelor, and clopidogrel in patients undergoing percutaneous coronary intervention: A network meta-analysis

Cited by 29 publications

References 68 publications

Culprit and Nonculprit Recurrent Ischemic Events in Patients With Myocardial Infarction: Data From SWEDEHEART (Swedish Web System for Enhancement and Development of Evidence‐Based Care in Heart Disease Evaluated According to Recommended Therapies)

Culprit and Nonculprit Recurrent Ischemic Events in Patients With Myocardial Infarction: Data From SWEDEHEART (Swedish Web System for Enhancement and Development of Evidence‐Based Care in Heart Disease Evaluated According to Recommended Therapies)

Head to head comparison of Prasugrel versus Ticagrelor in patients with acute coronary syndrome: a systematic review and meta-analysis of randomized trials

Consensus on the Rational Use of Antithrombotics in Veterinary Critical Care (CURATIVE): Domain 3—Defining antithrombotic protocols

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