Post percutaneous coronary interventional adverse cardiovascular outcomes and bleeding events observed with prasugrel versus clopidogrel: direct comparison through a meta-analysis

Abstract

BackgroundDue to limitations associated with clopidogrel following percutaneous coronary intervention (PCI), other newer oral anti-platelet agents are being studied. We aimed to systematically carry out a direct comparison of outcomes observed with prasugrel versus clopidogrel following PCI.MethodsCommon online searched databases (The Cochrane library, EMBASE, MEDLINE and Google scholar) were used to retrieve relevant publications. Primary endpoints were the adverse cardiovascular outcomes. Secondary outcomes were the bleeding events. This analysis was carried out by RevMan 5.3, whereby odds ratios (OR) and 95% confidence intervals (CI) were considered as the statistical parameters.ResultsEight studies with a total number of 18,122 participants were included in this direct analysis. Prasugrel was associated with significantly lower adverse cardiovascular outcomes in comparison to clopidogrel following PCI. All-cause mortality, myocardial infarction, stroke, stent thrombosis and major adverse cardiac events were all significantly lower with prasugrel (OR: 0.47, 95% CI: 0.35–0.63; P = 0.0001), (OR: 0.68, 95% CI: 0.57–0.80; P = 0.00001), (OR: 0.60, 95% CI: 0.38–0.96; P = 0.03), (OR: 0.46, 95% CI: 0.30–0.72; P = 0.0006) and (OR: 0.61, 95% CI: 0.53–0.70; P = 0.00001) respectively.When the bleeding outcomes were analyzed, Thrombolysis in Myocardial Infarction (TIMI) defined major and minor bleeding were not significantly different (OR: 0.91, 95% CI: 0.66–1.27; P = 0.59) and (OR: 1.16, 95% CI: 0.85–1.59; P = 0.35) respectively. However, the combined ‘all bleeding events’ was significantly higher with prasugrel (OR: 1.32, 95% CI: 1.03–1.70; P = 0.03), but when patients with STEMI and those undergoing elective PCI were separately analyzed, no significant difference in overall bleeding was observed.ConclusionAdverse cardiovascular outcomes were significantly lower with the use of prasugrel in comparison to clopidogrel following PCI. In addition, TIMI defined major and minor bleeding were not significantly different showing prasugrel to be well-tolerated following PCI especially in patients with acute coronary syndrome.

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

“…Although there are higher risks of GIB and non‐CABG major bleeding with third‐generation P2Y 12 inhibitors than clopidogrel, use of third‐generation P2Y 12 inhibitors were associated with significant reduction in the mortality risk and major adverse cardiac events as compared with clopidogrel in patients with ACS as shown in previous RCTs and meta‐analysis . A meta‐analysis including nine RCTs also showed that the effect of prasugrel in decreasing the risk of major adverse cardiac events outweighed the increased risk of bleeding .…”

Short‐term vs long‐term dual antiplatelet therapy after drug‐eluting stent implantation in patients undergoing percutaneous coronary intervention: A systematic review and meta‐analysis

“…41 Prasugrel and ticagrelor, novel oral P2Y12 receptor inhibitors, can play a role in patients not sensitive to clopidogrel. 42,43 With the application of new devices and new P2Y12 receptor inhibitors in the clinic, the duration of DAPT can be shortened.…”

“…With the development of metal stent frameworks, polymer coatings and released antiproliferation agents, DESs have reduced the incidence of thrombogenicity 41 . Prasugrel and ticagrelor, novel oral P2Y12 receptor inhibitors, can play a role in patients not sensitive to clopidogrel 42,43 . With the application of new devices and new P2Y12 receptor inhibitors in the clinic, the duration of DAPT can be shortened.…”

The risk of dyspnea in patients treated with third-generation P2Y12 inhibitors compared with clopidogrel: a meta-analysis of randomized controlled trials

“…Bleeding, as the most common side effects of thirdgeneration oral P2Y 12 inhibitors, has been well evaluated in previous studies [5][6][7]. Dyspnea was another important side effect, which was commonly reported in thirdgeneration oral P2Y 12 inhibitors users.…”