<p>Comparisons between ticagrelor and clopidogrel following percutaneous coronary intervention in patients with acute coronary syndrome: a comprehensive meta-analysis</p>

Abstract

Background:The efficacy and safety of ticagrelor following percutaneous coronary intervention for patients with acute coronary syndrome remains unclear. This study sought to evaluate clinical outcomes of ticagrelor as part of dual-antiplatelet treatment for these patients. Methods: PubMed, MEDLINE, Embase, and other Internet sources were searched for eligible citations. The primary end point was major adverse cardiovascular and cerebrovascular events, consisting of cardiovascular death, myocardial infarction, and stroke. The secondary end point was the occurrence of definite/probable stent thrombosis (ST). The risk of bleeding was chosen to be the safety end point. Results: Eleven clinical trials -six randomized trials and five observational trials -were finally analyzed. A tendency toward reduction in the risk of major adverse cardiovascular and cerebrovascular events was observed only with respect to ticagrelor (OR 0.83, 95% CI 0.66-1.03; P=0.091), which might have resulted from the lower risk of cardiovascular death (OR 0.78, 95% CI 0.68-0.89; P,0.001). The overall incidence of ST differed significantly between the ticagrelor group and the clopidogrel group (OR 0.74, 95% CI 0.59-0.93; P=0.009), but the risk of bleeding, regardless of major or minor bleeding, increased significantly. Conclusion: As part of dual-antiplatelet treatment following percutaneous coronary intervention, ticagrelor significantly reduced the risk of cardiovascular death and ST in acute coronary syndrome patients, but at the cost of bleeding. More powerful relevant randomized trials are still warranted to guide clinical decision-making.

Comparison of Clinical Outcomes Between Ticagrelor and Clopidogrel in Acute Coronary Syndrome: A Comprehensive Meta-Analysis

“…These metaanalyses got no consensus on the efficacy and safety of ticagrelor treatment. They either mixed all studies together and ignored the heterogeneity between clinical trials and observational studies, or did not perform further subgroup analyses based on other studies (or population) characteristics (13,15,16). In this metaanalysis, we performed prespecified subgroup analyses for MACE and bleeding in RCTs according to PCI strategy, ethnicity, country, and follow-up duration.…”

“…However, other large clinical trials (8,9) and observational studies (10)(11)(12) drew controversial conclusions. Meanwhile, several metaanalyses published recently also reported inconsistent results (13)(14)(15)(16). Therefore, we conducted a meta-analysis to review previous relevant studies and compared the clinical benefits of ticagrelor and clopidogrel in the ACS population using aspirin to address these conflicting conclusions.…”

Comparison of major bleeding in patients with acute coronary syndrome that underwent coronary artery bypass grafting treated with clopidogrel or ticagrelor: a systematic review and meta-analysis

“…A study conducted by Fan et al . 38 found that clopidogrel was associated with increased risk of major bleeding compared to ticagrelor. On the other hand, Guan et al .…”

Efficacy and safety of intracoronary prourokinase during percutaneous coronary intervention in treating ST-segment elevation myocardial infarction patients: a randomized, controlled study

“…Cardiovascular and hemorrhagic complications are the most common adverse events post PCI treatment, what's more important is that they are also fatal complications in STEMI patients, for instance, the atrial fibrillation, heart failure and stroke caused by intracranial hemorrhage [18][19][20][21][22][23]. In a previous clinical trial, the proportions of deaths, post-infarction angina, re-infarction/ reocclusion and emergency revascularization were 4.48, 15.2, 4.21, and 8.27% in STEMI patients treated by prourokinase during PCI [6].…”