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Efficacy and Safety of Ticagrelor Compared to Clopidogrel in Patients Undergoing Percutaneous Coronary Intervention:
Haihong Wu1, Xiuying Xiang2, Dandan Li1
1Department of Pharmacy, Beijing Friendship Hospital, Capital Medical University, 100050, Beijing, China.
Insights
Ticagrelor plus aspirin (TA) is more effective for major adverse cardiac events than clopidogrel plus aspirin (CA) in European/American populations. Asian populations also benefit, but with a higher risk of bleeding events with TA.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Research
Background:
- The Platelet Inhibition and Patient Outcomes (PLATO) study suggested ticagrelor plus aspirin (TA) superiority over clopidogrel plus aspirin (CA) post-percutaneous coronary intervention (PCI).
- Controversy exists regarding these findings, necessitating further investigation into TA versus CA efficacy and safety in acute coronary syndrome (ACS) patients after PCI.
Approach:
- A systematic literature search was conducted across MEDLINE, EMBASE, and Cochrane databases.
- Meta-analysis of 13 studies (58,062 patients) compared TA and CA, analyzing major adverse cardiac events (MACEs), death, stroke, myocardial infarction (MI), stent thrombosis, and bleeding events.
- Subgroup analysis included European/American and Asian populations, adhering to PRISMA guidelines.
Key Points:
- TA demonstrated superior effectiveness in reducing MACEs across European, American, and Asian populations compared to CA.
- While overall bleeding risk showed no significant difference, Asian populations experienced a statistically significant increase in bleeding events with TA.
- Specific effectiveness indicators like stroke, MI, and stent thrombosis showed inconsistent results between TA and CA across different populations.
Conclusions:
- Ticagrelor plus aspirin (TA) offers significant benefits for European and American ACS patients undergoing PCI compared to clopidogrel plus aspirin (CA).
- Asian populations also experience efficacy benefits with TA, but this is accompanied by a significantly increased risk of bleeding events.
- Careful consideration of antiplatelet drug choice is crucial, particularly for Asian patients, balancing efficacy with bleeding risk.
Background:
The Platelet Inhibition and Patient Outcomes (PLATO) study found that ticagrelor plus aspirin (TA) was more effective than clopidogrel plus aspirin (CA), without an increase in the risk of massive bleeding in patients undergoing percutaneous coronary intervention (PCI). Data from other studies indicate that the conclusion is controversial with the results obtained by PLATO.
Aim:
To investigate the efficacy and safety of TA, compared with CA, in patients with acute coronary syndrome (ACS) after PCI.
Methods:
A systematic literature search was performed in the MEDLINE, EMBASE, and Cochrane databases to compare the efficacy and safety of CA and TA treatment in patients with ACS after PCI. The endpoints were major adverse cardiac events (MACEs), death, stroke, myocardial infarction (MI), stent thrombosis, and bleeding events. The data analysis was performed using RevMan 5.3 software, and the odds ratios (ORs) and their 95% confidence intervals (CI) were calculated. The standards of reporting were in accordance with the PRISMA guidelines.
Results:
13 studies with a total of 58,062 patients were included in this study with a subgroup analysis of the European/American and Asian populations. In terms of effectiveness for MACEs, the European, American and Asian populations benefitted more from the TA treatment than the CA treatment (European and American populations, OR = 0.82, P = 0.0002; Asian, OR = 0.66, P < 0.0001; total, OR = 0.78, P < 0.0001). In terms of specific effectiveness indicators, such as stroke, MI, and stent thrombosis, the results of TA and CA groups in the European, American, and Asian populations were not consistent. In terms of safety, there was no statistical difference in total bleeding events between TA and CA treatments (OR = 1.19, P = 0.21). However, in the Asian population, the incidence of total bleeding events (OR = 1.52, P = 0.0004) in the TA group was higher than that in the CA group.
Conclusion:
The TA treatment in the European and American populations is more beneficial and safer than CA treatment. However, although the Asian population has this benefit, the risk of bleeding is significantly increased as well, and antiplatelet drugs should be chosen carefully.
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