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Ticagrelor Versus Clopidogrel as Part of Dual or Triple Antithrombotic Therapy: a Systematic Review and Meta-Analysis

Ioannis Andreou1, Alexandros Briasoulis2, Christos Pappas1

  • 12nd Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, Rimini 1, Chaidari, 124 62, Athens, Greece.

Cardiovascular Drugs and Therapy
|May 17, 2018
PubMed

Insights

Ticagrelor increases bleeding risk compared to clopidogrel in patients needing antiplatelet therapy and oral anticoagulation. Ticagrelor may also raise adverse cardiovascular events in triple therapy patients.

Area of Science:

  • Cardiology
  • Pharmacology

Background:

  • Clopidogrel is the standard P2Y12 receptor inhibitor for patients requiring both antiplatelet therapy and oral anticoagulation (OAC).
  • Investigating ticagrelor as an alternative to clopidogrel in this patient population is crucial for optimizing treatment strategies.

Purpose of the Study:

  • To evaluate the safety and efficacy of ticagrelor compared to clopidogrel in patients on oral anticoagulation (OAC).

Main Methods:

  • A systematic literature search was conducted across MEDLINE, EMBASE, and the Cochrane Library.
  • Randomized controlled trials comparing clopidogrel and ticagrelor in patients on antiplatelet agents plus OAC were included.

Main Results:

  • Three trials involving 5659 patients were analyzed.
  • Ticagrelor significantly increased the risk of clinically significant bleeding in both dual and triple antithrombotic therapy groups compared to clopidogrel.
  • In triple therapy, ticagrelor was associated with a higher risk of major adverse cardiovascular events (MACE), while dual therapy showed similar MACE and stroke risks.

Conclusions:

  • Ticagrelor use in dual or triple antithrombotic therapy is linked to increased bleeding complications versus clopidogrel.
  • Ticagrelor may elevate the risk of thromboembolic and ischemic cardiac events in patients on triple therapy.
Abstract

Keywords:
AnticoagulantsAntiplateletsAtrial fibrillationHaemorrhageMeta-analysis

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