Comparison of the Antiplatelet Effects of Once and Twice Daily Low-Dose Ticagrelor and Clopidogrel After Percutaneous Coronary Intervention

Choi, Kyu-Nam; Jin, Han-Young; Shin, Hyun-June; Park, Youngah; Seo, Jeong-Sook; Yang, Tae–Hyun; Kim, Dae-Kyeong; Kim, Dong-Soo

doi:10.1016/j.amjcard.2017.04.010

Cited by 17 publications

(10 citation statements)

References 21 publications

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“…A total of 80 potential eligible studies were then reviewed for full‐text evaluations, of which 39 articles were excluded because they did not meet the inclusion criteria (Table S1). Finally, 41 RCTs were included in the meta‐analysis with 23 trials comparing ticagrelor with clopidogrel and 18 trials comparing prasugrel with clopidogrel, in which bleeding data from ClinicalTrial.gov were used for the study of Ge 2010 . The selection steps and specific excluding reasons were shown in Figure .…”

Section: Resultsmentioning

confidence: 99%

Systematic review with meta‐analysis: the risk of gastrointestinal bleeding in patients taking third‐generation P2Y₁₂ inhibitors compared with clopidogrel

Guo

Chen

Chan

et al. 2018

Aliment Pharmacol Ther

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Summary Background Ticagrelor and prasugrel are third‐generation oral P2Y12 receptor antagonists with rapid onset and pronounced platelet inhibition. However, higher overall bleeding rates have been reported for these agents when compared with clopidogrel. Aim To compare the risk of gastrointestinal bleeding (GIB) among users of third‐generation P2Y12 inhibitors with clopidogrel. Methods We systematically searched for published randomised controlled trials of ticagrelor or prasugrel versus clopidogrel until September 2018. The primary outcome was the risk of GIB among users of third‐generation P2Y12 inhibitors when compared to clopidogrel, expressed as risk ratio (RR) and 95% confidence interval (CI). The rates of non‐coronary artery bypass graft (CABG) major bleeding, life‐threatening bleeding, fatal bleeding, and intracranial bleeding were analysed as secondary outcomes. Results Forty‐one studies were included in the analysis of non‐CABG major bleeding, of which 12 were included in the analysis of GIB including 58 678 patients. Third‐generation P2Y12 inhibitors were associated with higher risk of GIB as compared with clopidogrel (RR 1.28, 95% CI 1.13‐1.46). The findings were consistent for upper (RR 1.32, 95% CI 1.05‐1.67) and unspecified GIB (RR 1.25, 95% CI 1.01‐1.53), but not lower GIB (RR 1.25, 95% CI 0.95‐1.65). Subgroup analysis showed higher GIB risk in prasugrel studies (RR 1.40, 95% CI 1.10‐1.77) than in ticagrelor studies (RR 1.15, 95% CI 0.94‐1.39). Third‐generation P2Y12 inhibitors also increased the risk of non‐CABG major bleeding (RR 1.18, 95% CI 1.08‐1.28). Conclusion Third‐generation P2Y12 inhibitors were associated with increased risk of GIB and non‐CABG major bleeding when compared with clopidogrel.

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Section: Resultsmentioning

confidence: 99%

Systematic review with meta‐analysis: the risk of gastrointestinal bleeding in patients taking third‐generation P2Y₁₂ inhibitors compared with clopidogrel

Guo

Chen

Chan

et al. 2018

Aliment Pharmacol Ther

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“…Although recent studies provided promising findings, the current evidence is somewhat insufficient. The future large-scale investigations are warranted to reach definite conclusions 30, 31, 32…”

Section: Discussionmentioning

confidence: 97%

Ticagrelor for Asian patients with acute coronary syndrome in real-world practice: A systematic review and meta-analysis of observational studies

Galimzhanov

Azizov

2019

Indian Heart Journal

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ObjectiveWe aimed to assess the efficacy and safety of ticagrelor compared to clopidogrel in Asian patients with acute coronary syndrome (ACS) in real-world practice.MethodsPubMed, Web of Science and Scopus databases were searched systematically to obtain relevant Asian observational studies.ResultsThe meta-analysis included six studies with 27959 participants. Compared with clopidogrel, ticagrelor was significantly beneficial in prevention of major adverse cardiac events (MACCEs) (OR=0.62; 95% CI: 0.46-0.83, I2=69%, p=0.001) mainly driven by reducing stroke (OR=0.62; 95% CI: 0.49-0.78, I2=0%, p<0.001). No differences were found between ticagrelor and clopidogrel in the risk of cardiovascular mortality (OR=0.66; 95% CI: 0.41-1.06, I2=0%, p=0.09), target vessel revascularization (OR=0.53; 95% CI: 0.21-1.35, I2=82%, p=0.18), major bleeding (OR=1.11; 95% CI: 0.62-2.00, I2=75%, p=0.73), and net adverse clinical and cerebral events (OR=0.76; 95% CI: 0.55-1.04, I2=78%, p=0.09). However, ticagrelor significantly increased the incidence of major/minor (OR=1.73; 95% CI: 1.36-2.21, I2=0%, p<0.001) and minor bleeding (OR=1.73; 95% CI: 1.29-2.32, I2=0%, p<0.001). Sensitivity analyses did not find consistent effect of ticagrelor on prevention of all-cause death and myocardial infarction.ConclusionThis meta-analysis suggested that ticagrelor might reduce the risk of MACCEs mainly by reducing stroke in Asian patients with ACS without increasing the rates of major bleeding. Ticagrelor did not show a significant effect on other parts of MACCEs. Considerable increase in the risk of major/minor and minor bleeding was observed in ticagrelor compared with clopidogrel users. Further high-quality studies are required to support these findings.

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“…However, the antiplatelet effect of this regimen was considerably variable over time compared with other antiplatelet treatments, which may diminish any pleiotropic effects depending on its plasma concentration (reversibly binding) [35,36]. In PCI-treated patients, half-dose ticagrelor (45 mg twice daily) showed the lowest level of platelet reactivity (65.5 ± 58.8 PRU) compared with ticagrelor of 90 mg once daily (98.6 ± 73.4 PRU) and clopidogrel of 75 mg daily (221.2 ± 50.1 PRU) [37]. A crossover study including Chinese patients with stable CAD evaluated the antiplatelet effect of very low-dose of ticagrelor (22.5 mg twice daily) vs. standard-dose of clopidogrel (75 mg daily) for 7 days [38].…”

Section: Ticagrelormentioning

confidence: 99%

2018 update of expert consensus statement on antiplatelet therapy in East Asian patients with ACS or undergoing PCI

et al. 2019

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Comparison of the Antiplatelet Effects of Once and Twice Daily Low-Dose Ticagrelor and Clopidogrel After Percutaneous Coronary Intervention

Cited by 17 publications

References 21 publications

Systematic review with meta‐analysis: the risk of gastrointestinal bleeding in patients taking third‐generation P2Y₁₂ inhibitors compared with clopidogrel

Systematic review with meta‐analysis: the risk of gastrointestinal bleeding in patients taking third‐generation P2Y₁₂ inhibitors compared with clopidogrel

Ticagrelor for Asian patients with acute coronary syndrome in real-world practice: A systematic review and meta-analysis of observational studies

2018 update of expert consensus statement on antiplatelet therapy in East Asian patients with ACS or undergoing PCI

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Comparison of the Antiplatelet Effects of Once and Twice Daily Low-Dose Ticagrelor and Clopidogrel After Percutaneous Coronary Intervention

Cited by 17 publications

References 21 publications

Systematic review with meta‐analysis: the risk of gastrointestinal bleeding in patients taking third‐generation P2Y12 inhibitors compared with clopidogrel

Systematic review with meta‐analysis: the risk of gastrointestinal bleeding in patients taking third‐generation P2Y12 inhibitors compared with clopidogrel

Ticagrelor for Asian patients with acute coronary syndrome in real-world practice: A systematic review and meta-analysis of observational studies

2018 update of expert consensus statement on antiplatelet therapy in East Asian patients with ACS or undergoing PCI

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Product

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Systematic review with meta‐analysis: the risk of gastrointestinal bleeding in patients taking third‐generation P2Y₁₂ inhibitors compared with clopidogrel

Systematic review with meta‐analysis: the risk of gastrointestinal bleeding in patients taking third‐generation P2Y₁₂ inhibitors compared with clopidogrel