Comparison of treatment outcomes of ticagrelor and clopidogrel among patients undergoing percutaneous coronary intervention: A meta-analysis

Abstract

We performed a meta-analysis of randomized controlled trials (RCTs) to investigate the efficacy and safety of ticagrelor (TIC) vs. clopidogrel (CLO) in patients undergoing percutaneous coronary intervention (PCI). In Jun 2016, a literature search was started and all the studies were conducted from 2010 to 2015. We systematically searched the literature through the MEDLINE database, Cochrane library, and EMBASE database. Quality assessments were evaluated with Jadad quality scale. Data were extracted considering the characteristics of efficacy and safety designs. Six RCTs enrolling 26 244 participants and satisfying the inclusion criteria were finally analyzed. There was a significant decrease of all-cause mortality (MD=0.83, 95%CI=0.74-0.93, P=0.001) and myocardial infarction (MI) (MD=0.78, 95%CI=0.70-0.88, P=0.000). There were no significant differences in stroke (MD=1.34, 95%CI=0.99-1.79, P=0.06), total bleeding (MD=0.97, 95%CI=0.84-1.12, P=0.66), minor or major bleeding (MD=1.06, 95%CI=0.94-1.19, P=0.35) in patients undergoing PCI after treatment with TIC vs. CLO. TIC could be more significant in decreasing all-cause mortality and MI than CLO, but there were no significant differences between TIC and CLO in inhibiting stroke, major bleeding, major or minor bleeding in patients undergoing PCI.

Risk of bleeding with ticagrelor in elderly patients over 75 years old

“…In this study, we found no statistically significant difference in the risk of a major or minor bleeding in patients exposed to ticagrelor compared to clopidogrel. This was consistent with the findings of a previous meta-analysis in younger patients which showed that major and minor bleeding events did not differ with either ticagrelor or clopidogrel [36] . However, this finding needs to be interpreted with caution.…”

“…This was consistent with the findings of a previous meta-analysis in younger patients which showed that major and minor bleeding events did not differ with either ticagrelor or clopidogrel. [36] However, this finding needs to be interpreted with caution. All the various studies included in this review had varying definitions for major and minor bleeding.…”

Choosing between ticagrelor and clopidogrel following percutaneous coronary intervention

“…A recently published meta-analysis showed that major and minor bleeding events were not significantly different with either ticagrelor or clopidogrel. [ 32 ] Nevertheless, the study involved only 6 trials and included only studies which were published between the years 2010 and 2015.…”

Yeni Kardiyovasküler İlaçların Gebe Hastalarda Kullanımı: Teratojenik Riskler

“…Son birkaç yılda antikoagulan, antitrombositik ve antilipidemik ilaç gruplarında, mevcut tedavilere alternatif olarak yeni ajanlar geliştirilmiştir [1][2][3] . Birçok ülkede bu yeni ilaçların reçetelenme oranındaki artış, gebeliğinin farkında olmadan bu ajanları kullanan kadın hastaların ve neticesinde fetüsün ilaçlara istenmeden maruz kalması konusunu gündeme getirmektedir.…”

“…Ayrıca maternal maruziyetin olduğu gestasyonel dönem ve kullanılan ilacın dozu da fetal risk analizi yapılırken göz önüne alınmalıdır. Zira gebeliğin 3-8. haftalar arasında olan organogenezis dönemi maternal ilaç maruziyetlerinin fetüste potansiyel teratojenik etki yapabileceği gebelik dönemi olarak bilinmektedir 2,3 .…”