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Published on: November 8, 2024
The Effect of Ticagrelor on Endothelial Function Compared to Prasugrel, Clopidogrel, and Placebo: A Systematic Review
Baoyi Guan1,2, Lin Zhao3, Dan Ma1,2
1Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China.
Insights
Ticagrelor significantly improves endothelial function markers, including flow-mediated dilation and reactive hyperemia index, in coronary artery disease patients. Further research is needed due to study heterogeneity.
Area of Science:
- Cardiovascular Medicine
- Pharmacology
- Medical Research
Background:
- Endothelial dysfunction is a key factor in long-term outcomes for coronary artery disease (CAD) patients.
- Ticagrelor, a potent antiplatelet agent, has shown potential in improving endothelial function, but evidence is conflicting.
- This meta-analysis aimed to clarify ticagrelor's efficacy on endothelial function in CAD patients.
Approach:
- A systematic literature review was performed across major scientific databases (PubMed, Web of Science, EMBASE, Scopus, Cochrane Library).
- Randomized controlled trials (RCTs) published up to August 2021 were assessed for quality using the Cochrane tool.
- Data were pooled using fixed- or random-effect models to calculate the overall effect size (weighted mean difference with 95% confidence intervals).
Key Points:
- Ticagrelor significantly increased flow-mediated dilation (FMD) (WMD: 1.48; 95% CI: 0.36, 2.60).
- Ticagrelor significantly improved reactive hyperemia index (RHI) (WMD: 0.06; 95% CI: 0.00, 0.13) and circulating endothelial progenitor cells (CEPCs) (WMD: 13.84; 95% CI: 5.70, 21.98).
- Ticagrelor significantly reduced the index of microvascular resistance (IMR) (WMD: -15.39; 95% CI: -25.11, -5.68).
Conclusions:
- Ticagrelor demonstrates a significant positive impact on several key markers of endothelial function in patients with coronary artery disease.
- The findings suggest ticagrelor may be beneficial for improving endothelial health in this patient population.
- Caution is advised when interpreting results due to observed heterogeneity and a limited number of studies.
Background/Objective:
Endothelial dysfunction is associated with the long-term outcomes in patients with coronary artery disease (CAD). Recent evidence suggests that ticagrelor, a potent antiplatelet agent, improves endothelial function. However, several studies demonstrated contrasting results. The objective of this meta-analysis was to determine the efficacy of ticagrelor treatment on endothelial function.
Materials And Methods:
A systematic literature study was conducted on databases including PubMed, Web of Science, EMBASE, Scopus, and the Cochrane Library. A historical search was performed for a reference list of the selected studies as of August 2021. The randomized controlled trials (RCTs) were assessed using the Cochrane tool. The weighted mean difference (WMD) 95% CI was treated as the overall effect size, and data were pooled using the fixed-effect model or random-effect model according to the heterogeneity. Subgroup and sensitivity analyses were performed to measure the effects of potential confounders.
Results:
A total of 21 studies were included. The meta-analysis indicated that ticagrelor resulted in a significant increase of flow-mediated dilation (FMD) (WMD: 1.48; 95% CI: 0.36, 2.60), reactive hyperemia index (RHI) (WMD: 0.06; 95% CI: 0.00, 0.13), and circulating progenitor endothelial cells (CEPCs) (WMD: 13.84; 95% CI: 5.70, 21.98), and a reduction in the index of microvascular resistance (IMR) (WMD: -15.39; 95% CI: -25.11, -5.68).
Conclusion:
Ticagrelor has a significant effect on some markers of endothelial function in patients with CAD. However, the results should be interpreted with caution due to the heterogeneity and limited studies.
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