Effects of clopidogrel, prasugrel and ticagrelor on prevention of stent thrombosis in patients underwent percutaneous coronary intervention: A network meta‐analysis

Abstract

Background Clopidogrel, prasugrel and ticagrelor, acting on platelet P2Y12 receptor, are commonly used for prevention of stent thrombosis (ST) among patients who underwent percutaneous coronary intervention (PCI). This study aimed to compare the effects of these drugs by a systematic review and network meta‐analysis. Hypothesis Efficacies of clopidogrel, prasugrel and ticagrelor on preventing ST are not the same. Methods PubMed, Embase and Cochrane Library were searched for randomized controlled trials (RCTs) that investigated the effect of clopidogrel, prasugrel, or ticagrelor on prevention of ST in patients who underwent PCI. The efficacies between groups were compared by a Bayesian network meta‐analysis, by which the pooled odds ratios (ORs) and 95% confidence intervals (CIs) was calculated. Results Fourteen studies and 46 983 participants were included in this study. The pooled results illustrated that clopidogrel, prasugrel and ticagrelor were effective on prevention of ST. Patients treated with prasugrel (OR = 0.30, 95% CI = 0.052 ~ 0.73, P < 0.05) and ticagrelor (OR = 0.25, 95% CI = 0.035 ~ 0.65, P < 0.05) had lower incidence of ST compared to those treated with clopidogrel. Patients treated with ticagrelor showed similar frequency with those in prasugrel group (OR = 0.86, 95% CI = 0.22 ~ 2.3, P > 0.05). No significant heterogeneity was observed across included studies. Conclusions Our findings suggest that prasugrel and ticagrelor are more effective than clopidogrel on prevention of ST among patients underwent PCI. Simultaneously, there is no significant difference in the prevention of ST between prasugrel and ticagrelor.

Comparative efficacy and safety of oral P2Y12inhibitors after non-ST-elevation acute coronary syndromes: a network meta-analysis

“…Lastly, stent thrombosis rates were significantly reduced with prasugrel compared with clopidogrel, but not with ticagrelor and there was not a significant difference between the potent P2Y 12 inhibitors. A network meta-analysis in the overall ACS population reports similar results 28…”

Three versus 12‐month dual antiplatelet therapy duration in patients with acute coronary syndrome undergoing percutaneous coronary intervention: A meta‐analysis of randomized controlled trials

“…Our study suggests that 3-month DAPT may be a safer option in ACS patients than 12-month DAPT. It is well established that compared with clopidogrel, prasugrel and ticagrelor provide superior cardiovascular protection 28,29 ; however, the risk of bleeding is also increased. 30,31 Future studies should assess the comparative efficacy of clopidogrel versus ticagrelor or prasugrel monotherapy after abbreviated DAPT.…”

Discharge of Acute Coronary Syndrome Patients on Sub-Optimal Dual Anti-Platelet Therapy: A Single Center Experience

“…Ticagrelor is currently accepted as a superior P2Y 12 inhibitor treatment in patients who have undergone PCI for ACS, based largely on a randomized controlled trial[ 2 ] and non-randomized cohort studies[ 4 – 6 ]. This finding has been reinforced by a 2020 meta-analysis of 52,816 patients that found a decreased risk of mortality and ischemic events in ticagrelor over clopidogrel[ 15 ].…”

“…The effect of ticagrelor, unlike clopidogrel, on platelet aggregation were also shown to be unaffected by genetic polymorphisms of CYP2C19[ 3 ], suggesting less variance of efficacy in different populations. Based on randomized controlled trials and non-randomized cohort studies[ 4 – 6 ], the 2021 ACC/AHA revascularization guidelines[ 7 ] and European Society of Cardiology guidelines[ 8 ] recommend ticagrelor or prasugrel over clopidogrel for acute coronary syndrome (ACS) patients. Despite this, there has been incomplete adoption of prasugrel/ticagrelor over clopidogrel over the past decade, based on the higher cost of the former, the trade-off between bleeding and anti-thrombotic effects, which are both higher with the former and data from large cohort studies suggest similar efficacy in real-world ACS patients.…”