Comparison of prasugrel and ticagrelor in patients with acute coronary syndrome undergoing percutaneous coronary intervention: A meta-analysis of randomized and non-randomized studies

Watti, Hussam; Dahal, Khagendra; Zabher, Henock; Katikaneni, Pavan; Modi, Kalgi; Abdulbaki, Abdulrahman

doi:10.1016/j.ijcard.2017.07.103

Cited by 23 publications

(18 citation statements)

References 38 publications

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“…This was confirmed by a subsequent metaanalysis, which showed that for STEMI patients undergoing PCI, prasugrel was superior to ticagrelor, particularly in conjunction with bivalirudin and drug-eluting stents [15]. Direct evidence was presented in a recently published meta-analysis of head-to-head RCTs, in which prasugrel appeared equivalent or superior to ticagrelor for patients with acute coronary syndrome undergoing PCI at the 30-day follow-up [20]. However, whether prasugrel based-TAPTs are superior to ticagrelor based-TAPTs in STEMI patients undergoing PCI remains to be determined.…”

Section: Discussionmentioning

confidence: 86%

Prasugrel or ticagrelor relative to clopidogrel in triple-antiplatelet treatment combined with glycoprotein IIb/IIIa inhibitor for patients with STEMI undergoing PCI: a meta-analysis

Wang¹,

Zhou²,

Su³

et al. 2020

BMC Cardiovasc Disord

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Background: For patients with ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI), the efficacy and safety of novel P2Y 12 antagonists, including prasugrel or ticagrelor, has not been established relative to that of the clopidogrel-based triple-antiplatelet treatments (TAPTs; in combination with glycoprotein IIb/IIIa inhibitor). The present meta-analysis evaluated the efficacy and safety of prasugrel-or ticagrelor-based TAPTs relative to that of clopidogrel TAPTs in patients with STEMI undergoing PCI. Methods: The databases PubMed, Embase, and Cochrane's Library were systematically searched for relevant randomized controlled trials concerning prasugrel or ticagrelor (test) relative to clopidogrel (control). Depending on heterogeneity, studies were pooled with a random effects or a fixed effects model. Outcomes of blood flow after PCI were evaluated, including TIMI (thrombolysis in myocardial infarction), bleeding events, and major adverse cardiovascular events (MACEs). Results: Seven studies comprising 11,874 patients conformed to the inclusion criteria. The pooled results with the fixed effects model indicated that after PCI patients in the prasugrel or ticagrelor groups were as likely as those treated with clopidogrel to achieve TIMI grade 3 flow or experience bleeding events. However, compared with the control, the test groups had significantly less risk of MACE (OR: 0.81, 95% CI: 0.70-0.94, P = 0.004), especially at the 1-year follow-up (OR: 0.79, 95% CI: 0.66-0.95, P = 0.01). Conclusions: A prasugrel-or ticagrelor-based TAPT may reduce the rate of MACEs, without increasing bleeding in STEMI patients undergoing PCI. However, due to the limited RCT studies and variations in study weight, results of this metaanalysis should be confirmed in a large RCT with adequate sample size and follow-up duration.

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Section: Discussionmentioning

confidence: 86%

Prasugrel or ticagrelor relative to clopidogrel in triple-antiplatelet treatment combined with glycoprotein IIb/IIIa inhibitor for patients with STEMI undergoing PCI: a meta-analysis

Wang¹,

Zhou²,

Su³

et al. 2020

BMC Cardiovasc Disord

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“…Collectively, these results highlight the therapeutic advancement with the introduction of ticagrelor and prasugrel, making both drugs attractive alternatives to clopidogrel therapy in patients with ACS. Several studies compared the effectiveness and/or safety of ticagrelor and prasugrel, but they were limited to single centers, had small sample sizes, analyzed short‐term outcomes only (e.g., those occurring within hospital stay), and pooled a heterogeneous patient population . Therefore, it remains unclear whether there is a difference in the effectiveness and safety between ticagrelor and prasugrel in real‐world settings and across different subgroups of patients with ACS.…”

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confidence: 99%

Comparative Effectiveness and Safety of Ticagrelor versus Prasugrel in Patients with Acute Coronary Syndrome: A Retrospective Cohort Analysis

et al. 2019

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STUDY OBJECTIVE To compare the effectiveness and safety of ticagrelor versus prasugrel in preventing recurrent cardiovascular disease (CVD) and major bleeding events in patients with acute coronary syndrome (ACS). DESIGN Retrospective cohort analysis. DATA SOURCE Truven Commercial and Medicare Supplemental claims database (2011)(2012)(2013)(2014)(2015)(2016). PATIENTS Study consisted of adults with ACS who newly initiated ticagrelor or prasugrel within 7 days of their first ACS diagnosis and had no prior use for at least 12 months; after propensity score matching, 10,073 patients were in each group. METHODS The primary study outcomes, first occurrence of a recurrent nonfatal CVD event (composite of myocardial infarction and stroke) and occurrence of a major bleeding event, were compared between the ticagrelor and prasugrel groups. Secondary outcomes included occurrence of minor bleeding events, defined based on the presence of bleeding events in outpatient claims. Cox proportional hazards models after propensity score matching were used to obtain the hazard ratio (HR) and 95% confidence interval (CI). In the Cox proportional hazards model, the use of ticagrelor was associated with a decreased risk of recurrent nonfatal CVD events (HR 0.80, 95% CI 0.70-0.92) and major bleeding events (HR 0.54, 95% CI 0.41-0.70) compared with prasugrel. Additionally, the use of ticagrelor was associated with a lower risk of minor bleeding events compared with prasugrel (HR 0.71, 95% CI 0.65-0.78). CONCLUSION In this population-based cohort of incident ACS patients, ticagrelor was associated with a reduced rate of recurrent nonfatal CVD events, major and minor bleeding events compared with prasugrel. KEY WORDS acute coronary syndrome, ticagrelor, prasugrel, effectiveness. (Pharmacotherapy 2019;39(9):912-920)

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“…10 A ausência de desfechos indesejados 30 dias após a ICP em nossa amostra, bem como a necessidade de nova revascularização não relacionada ao vaso anteriormente abordado após 12 meses demonstra eficácia e segurança tardias do BVS e também pode ter relação com a alta prevalência de DAP, em consonância com a recomendação a fim de evitar casos de trombose tardia. 27 O estudo de coorte ABSORB A acompanhou 30 pacientes tratados com Absorb ® durante cinco anos nos Países Baixos e verificou um único episódio de dor torácica com necessidade de nova revascularização, taxa de eventos adversos cardíacos maiores (ECAM) de 3,4%, ausência de trombose e patência de todos os stents. 28 Em seguida, o estudo de coorte ABSORB B mostrou que a bioabsorção ocorreu após três anos em 53 pacientes e associa-se a aumento tardio do lúmen, redução da placa e restauração da motilidade do vaso, com patência de 91%.…”

Section: Discussionunclassified

Desfechos clínicos dos pacientes submetidos à intervenção coronária percutânea com stent bioabsorvível eluidor de everolimus

Ribeiro¹,

Nascimento

Murakami

et al. 2018

Medicina (Ribeirao Preto. Online)

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Modelo: Estudo descritivo, transversal, retrospectivo. Objetivo: Identificar desfechos clínicos e a prevalência de uso da dupla antiagregação plaquetária (DAP) 30 dias e 12 meses após implante de stent bioabsorvível eluidor de everolimus (BVS). Metodologia e casuística: Foram coletados e analisados de maneira descritiva dados referentes a antecedentes clínicos, procedimento, resultados pós-procedimento e complicações intra-hospitalares, acompanhamento e antiagregação plaquetária 30 dias e um ano após implante de BVS de pacientes submetidos a intervenção coronária percutânea (ICP) com BVS. Resultados: 169 pacientes foram submetidos a 182 a ICP com BVS para tratamento de 298 lesões, com idade média de 56,9±10,8 anos, 84% do sexo masculino. Até quatro lesões foram abordadas por ICP, 49% na artéria descendente anterior, 81,2% graves (Ellis B2 e C), 99% em TIMI 3 pós-procedimento. Após o procedimento, o infarto agudo do miocárdio (IAM) sem supradesnivelamento do segmento ST foi a principal complicação intrahospitalar (11,5%). Trinta dias após a ICP, não houve complicações relacionadas ao procedimento e 93,4% estavam em DAP. Após um ano, três pacientes foram submetidos a nova ICP não relacionada ao vaso anteriormente abordado e 80,2% mantinham DAP. Ressalta-se que não ocorreu re-estenose clinicamente significativa no período de seguimento. Conclusão: A prevalência de uso de DAP foi alta e não houve complicações precoces ou tardias relacionadas à ICP com BVS, confirmando a segurança e efetividade do procedimento na instituição.

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Comparison of prasugrel and ticagrelor in patients with acute coronary syndrome undergoing percutaneous coronary intervention: A meta-analysis of randomized and non-randomized studies

Cited by 23 publications

References 38 publications

Prasugrel or ticagrelor relative to clopidogrel in triple-antiplatelet treatment combined with glycoprotein IIb/IIIa inhibitor for patients with STEMI undergoing PCI: a meta-analysis

Prasugrel or ticagrelor relative to clopidogrel in triple-antiplatelet treatment combined with glycoprotein IIb/IIIa inhibitor for patients with STEMI undergoing PCI: a meta-analysis

Comparative Effectiveness and Safety of Ticagrelor versus Prasugrel in Patients with Acute Coronary Syndrome: A Retrospective Cohort Analysis

Desfechos clínicos dos pacientes submetidos à intervenção coronária percutânea com stent bioabsorvível eluidor de everolimus

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