Switching from ticagrelor to clopidogrel in patients with ST‐segment elevation myocardial infarction undergoing successful percutaneous coronary intervention in real‐world China: Occurrences, reasons, and long‐term clinical outcomes

Li, Xinyun; Su, Guohai; Wang, Guangxin; Hu, Hongyan; Fan, Chunjie

doi:10.1002/clc.23074

Cited by 24 publications

(35 citation statements)

References 22 publications

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“…After exclusion of 874 studies by title and/or abstract, 36 articles were reviewed in full‐text. Finally, 14 studies 8,14‐26 that met all criteria were included in our meta‐analysis (Figure 1), with 46 983 participants. The duration of follow‐up was 11.1 ± 2.9 months, ranging from 6 to 15 months.…”

Section: Resultsmentioning

confidence: 99%

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

Chen

Zhang

Zhao

et al. 2021

Clinical Cardiology

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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.

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Section: Resultsmentioning

confidence: 99%

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

Chen

Zhang

Zhao

et al. 2021

Clinical Cardiology

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“…It may be considered an effective and practical strategy to reduce ischemic and bleeding events in elderly patients [37]. This recommendation is supported by several studies where ticagrelor was switched to clopidogrel in ACS patients undergoing PCI [38][39][40]. Still, the effectiveness and safety of this switching require more studies to determine the appropriate time for switching.…”

Section: Discussionmentioning

confidence: 99%

Coronary Heart Disease (CHD) in Elderly Patients: Which Drug to Choose, Ticagrelor and Clopidogrel? A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Akkaif

Sha’aban

Daud

et al. 2021

JCDD

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Background: A new generation P2Y12 receptor inhibitor (ticagrelor) is recommended in current therapeutic guidelines to treat patients with coronary heart disease (CHD). However, it is unknown if ticagrelor is more effective than clopidogrel in elderly patients. Therefore, a systematic review was done to assess the effectiveness and safety of ticagrelor and clopidogrel in older patients with CHD to determine the appropriate antiplatelet treatment plan. Methodology: We performed a systematic review of randomized controlled trials (RCTs) to compare the effectiveness and safety of ticagrelor vs. clopidogrel in elderly patients with CHD. We selected eligible RCTs based on specified study criteria following a systematic search of PubMed and Scopus databases from January 2007 to May 2021. Primary efficacy outcomes assessed were major adverse cardiovascular events (MACEs), myocardial infarction (MI), stent thrombosis (ST), and all-cause death. The secondary outcome assessed was major bleeding events. We used RevMan 5.3 software to conduct a random-effects meta-analysis and estimated the pooled incidence and risk ratios (RRs) with 95% confidence intervals (CIs) for ticagrelor and clopidogrel. Results: Data from 6 RCTs comprising 21,827 elderly patients were extracted according to the eligibility criteria. There was no significant difference in the MACE outcome (incidence: 9.23% vs. 10.57%; RR = 0.95, 95% CI = 0.70–1.28, p = 0.72), MI (incidence: 5.40% vs. 6.23%; RR = 0.94, 95% CI= 0.69–1.27, p = 0.67), ST (incidence: 2.33% vs. 3.17%; RR = 0.61, 95% CI= 0.32–1.17, p = 0.13), and all-cause death (4.29% vs. 5.33%; RR = 0.86, 95% CI = 0.65–1.12, p = 0.25) for ticagrelor vs. clopidogrel, respectively. In addition, ticagrelor was not associated with a significant increase in the rate of major bleeding (incidence: 9.98% vs. 9.33%: RR = 1.37, 95% CI = 0.97–1.94, p = 0.07) vs. clopidogrel. Conclusions: This study did not find evidence that ticagrelor is significantly more effective or safer than clopidogrel in elderly patients with CHD.

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“…[ 2 , 3 ] De-escalation (change from ticagrelor or prasugrel to clopidogrel) may be required due to major bleeding, ambiguity surrounding dose requirements for elderly patients/patients with low body weight using prasugrel, or cost. [ 51 – 53 ]…”

Section: Switching Antiplatelet Therapymentioning

confidence: 99%

“…[ 54 ] However, observational data from Asian patients have suggested that de-escalating DAPT in the absence of platelet-function-testing-guided clopidogrel dosing may increase the risk of ischaemic events without reducing bleeding risk. [ 38 , 51 , 53 , 55 ]…”

Section: Switching Antiplatelet Therapymentioning

confidence: 99%

2020 Asian Pacific Society of Cardiology Consensus Recommendations on the Use of P2Y12 Receptor Antagonists in the Asia-Pacific Region

et al. 2021

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The unique characteristics of patients with acute coronary syndrome in the Asia-Pacific region mean that international guidelines on the use of dual antiplatelet therapy (DAPT) cannot be routinely applied to these populations. Newer generation P2Y12 inhibitors (i.e. ticagrelor and prasugrel) have demonstrated improved clinical outcomes compared with clopidogrel. However, low numbers of Asian patients participated in pivotal studies and few regional studies comparing DAPTs have been conducted. This article aims to summarise current evidence on the use of newer generation P2Y12 inhibitors in Asian patients with acute coronary syndrome and provide recommendations to assist clinicians, especially cardiologists, in selecting a DAPT regimen. Guidance is provided on the management of ischaemic and bleeding risks, including duration of therapy, switching strategies and the management of patients with ST-elevation and non-ST-elevation MI or those requiring surgery. In particular, the need for an individualised DAPT regimen and considerations relating to switching, de-escalating, stopping or continuing DAPT beyond 12 months are discussed.

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Switching from ticagrelor to clopidogrel in patients with ST‐segment elevation myocardial infarction undergoing successful percutaneous coronary intervention in real‐world China: Occurrences, reasons, and long‐term clinical outcomes

Abstract: Switching from ticagrelor to clopidogrel is very common in patients with STEMI in China. De-escalation might be safe but associated with high risk of ischemic events as compared to ticagrelor.

Cited by 24 publications

References 22 publications

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

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

Coronary Heart Disease (CHD) in Elderly Patients: Which Drug to Choose, Ticagrelor and Clopidogrel? A Systematic Review and Meta-Analysis of Randomized Controlled Trials

2020 Asian Pacific Society of Cardiology Consensus Recommendations on the Use of P2Y12 Receptor Antagonists in the Asia-Pacific Region

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