Prasugrel Versus Ticagrelor in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention: a Systematic Review and Meta-analysis of Randomized Trials

Ray, Avik; Najmi, Ahmad; Khandelwal, Gaurav; Jhaj, Ratinder; Sadasivam, Balakrishnan

doi:10.1007/s10557-020-07056-z

Cited by 6 publications

(5 citation statements)

References 39 publications

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“…Other meta-analyses of the total ACS population have focused solely on the prasugrel versus ticagrelor comparison by analysing RCTs and observational studies together or by including studies not designed to primarily explore clinical outcomes. 23 24 Yet, they found no difference in cardiovascular outcomes between prasugrel and ticagrelor. Our meta-analysis differs from the already published evidence in focusing on the NSTE-ACS population and especially in those managed invasively.…”

Section: Discussionmentioning

confidence: 95%

“…Notably, in none of the explored outcomes there was a difference between ticagrelor and prasugrel, but they both increased major bleeding compared with clopidogrel. Other meta-analyses of the total ACS population have focused solely on the prasugrel versus ticagrelor comparison by analysing RCTs and observational studies together or by including studies not designed to primarily explore clinical outcomes 23 24. Yet, they found no difference in cardiovascular outcomes between prasugrel and ticagrelor.…”

Section: Discussionmentioning

confidence: 99%

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Comparative efficacy and safety of oral P2Y₁₂inhibitors after non-ST-elevation acute coronary syndromes: a network meta-analysis

et al. 2022

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BackgroundCurrently, potent P2Y12 inhibition with the use of prasugrel or ticagrelor is the mainstay of treatment after an acute coronary syndrome (ACS). The 2020 European Society of Cardiology (ESC) Guidelines recommend the use of prasugrel over ticagrelor in patients with non-ST-elevation ACS (NSTE-ACS) intended to receive invasive management (class IIa recommendation), however there are contradictory views regarding this recommendation.AimTo compare oral P2Y12 inhibitors in NSTE-ACS in terms of efficacy and safety with a focus on patients intended to proceed to invasive management.MethodsWe systematically searched PubMed, Cochrane Central Register of Controlled Trials and Web of Science to identify studies that compared different oral P2Y12 inhibitors (clopidogrel, prasugrel and ticagrelor) in patients with NSTE-ACS. Efficacy outcomes included the major adverse cardiovascular events outcome and safety outcomes included minor and major bleedings. We performed a frequentist network meta-analysis.ResultsNine studies (n=35 441 patients) were included in the systematic review. There was no difference between prasugrel and ticagrelor in the composite cardiovascular end point (prasugrel vs ticagrelor HR=0.80, 95% CI=0.61 to 1.06) in all patients with NSTE-ACS. In patients intended to receive invasive management, prasugrel resulted in a reduction of the composite cardiovascular end point both versus clopidogrel (HR=0.76, 95% CI=0.61 to 0.95) and ticagrelor (HR=0.74, 95% CI=0.56 to 0.98). Inconsistency was moderate and non-significant (I2=27%, total Q p=0.2). Prasugrel ranked as the most efficient treatment in the composite cardiovascular efficacy outcome, all-cause death, myocardial infarction and definite stent thrombosis, while clopidogrel ranked as safest in the bleeding outcomes.ConclusionIn patients with NSTE-ACS intended to receive invasive management, an antiplatelet strategy based on prasugrel is more efficient than a similar strategy based on ticagrelor on a moderate level of evidence. This analysis supports the current recommendations by the ESC guidelines.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Comparative efficacy and safety of oral P2Y₁₂inhibitors after non-ST-elevation acute coronary syndromes: a network meta-analysis

et al. 2022

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“…1 ). 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 From these systematic reviews, we identified 6 relevant RCTs. 14 , 24 , 25 , 26 , 27 , 28 We updated the search strategy from the most recent and comprehensive systematic review 15 to November 2022.…”

Section: Resultsmentioning

confidence: 99%

Potent P2Y12 Inhibitor Selection and De-escalation Strategies in Acute Coronary Syndrome Patients Undergoing Percutaneous Coronary Intervention: Systematic Review and Meta-analysis

Boivin-Proulx,

Bainey,

Marquis-Gravel

et al. 2024

CJC Open

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“…Due to limited data, results from observational studies had to be included in the pool estimate of previous meta-analysis, and the mean follow-up duration was 1 month [5]. A recent meta-analysis included ISAR-REACT 5 results [25]. However, investigators included the PRAGUE-18 population twice in the analysis which might have biased the result.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Prasugrel and Ticagrelor for Patients with Acute Coronary Syndrome: A Systematic Review and Meta-Analysis

et al. 2021

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Introduction: There has been inconsistent data on the direct comparison of prasugrel and ticagrelor. This meta-analysis was conducted to summarise the current available evidence. Methods: We performed a meta-analysis (PROSPERO-registered CRD42020166810) of randomized trials up to Feb 2020 that compared prasugrel and ticagrelor in acute coronary syndrome with respect to the composite endpoint of myocardial infarction (MI), stroke or cardiovascular death, and secondary endpoints including MI, stroke, cardiovascular death, major bleeding (Bleeding Academic Research Consortium (BARC) type 2 or above), stent thrombosis, all-cause death and other safety outcomes. Results: Of the 11 eligible RCTs with 6098 patients randomized to prasugrel (n=3050) or ticagrelor (n=3048), 180 and 207 had the composite endpoint events in the prasugrel arm and the ticagrelor arm respectively over a weighted mean follow up period of 11±2 months. Compared with prasugrel, the ticagrelor group had similar risk in the primary composite endpoint (Risk Ratio (RR)= 1.17; 95% CI=0.96-1.42; p=0.12, I2=0%). Compared to prasugrel, there was no significant difference associated with the use of ticagrelor groups with respect to stroke (RR=1.05; 95% CI=0.66-1.67; p=0.84, I2=0%); cardiovascular death (RR=1.01; 95% CI=0.75-1.36; p=0.95, I2=0%); BARC type 2 or above bleeding (RR=1.16; 95% CI =0.89-1.52; p=0.26, I2=0%); stent thrombosis (RR=1.58; 95% CI =0.90-2.76; p=0.11, I2=0%); all cause death (RR=1.10; 95% CI =0.86-1.43; p=0.45, I2=0%) except MI (RR=1.38; 95% CI=1.05-1.81; p=0.02, I2=0%) Conclusion: Compared with prasugrel, ticagrelor did not reduce the primary composite endpoint of MI, stroke and cardiovascular death at a weighted mean follow up of 11 months. There was no significant difference between the secondary outcomes except myocardial infarction.

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Prasugrel Versus Ticagrelor in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention: a Systematic Review and Meta-analysis of Randomized Trials

Cited by 6 publications

References 39 publications

Comparative efficacy and safety of oral P2Y₁₂inhibitors after non-ST-elevation acute coronary syndromes: a network meta-analysis

Comparative efficacy and safety of oral P2Y₁₂inhibitors after non-ST-elevation acute coronary syndromes: a network meta-analysis

Potent P2Y12 Inhibitor Selection and De-escalation Strategies in Acute Coronary Syndrome Patients Undergoing Percutaneous Coronary Intervention: Systematic Review and Meta-analysis

Comparison of Prasugrel and Ticagrelor for Patients with Acute Coronary Syndrome: A Systematic Review and Meta-Analysis

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Prasugrel Versus Ticagrelor in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention: a Systematic Review and Meta-analysis of Randomized Trials

Cited by 6 publications

References 39 publications

Comparative efficacy and safety of oral P2Y12inhibitors after non-ST-elevation acute coronary syndromes: a network meta-analysis

Comparative efficacy and safety of oral P2Y12inhibitors after non-ST-elevation acute coronary syndromes: a network meta-analysis

Potent P2Y12 Inhibitor Selection and De-escalation Strategies in Acute Coronary Syndrome Patients Undergoing Percutaneous Coronary Intervention: Systematic Review and Meta-analysis

Comparison of Prasugrel and Ticagrelor for Patients with Acute Coronary Syndrome: A Systematic Review and Meta-Analysis

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Comparative efficacy and safety of oral P2Y₁₂inhibitors after non-ST-elevation acute coronary syndromes: a network meta-analysis

Comparative efficacy and safety of oral P2Y₁₂inhibitors after non-ST-elevation acute coronary syndromes: a network meta-analysis