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Novel oral P2Y12 inhibitor prasugrel vs. clopidogrel in patients with acute coronary syndrome: evidence based on 6 studies.

Jia M, Li Z, Chu H, Li L, Chen K - Med. Sci. Monit. (2015)

Bottom Line: However, prasugrel was associated with significantly higher risk of both major bleeding (Pooled RR: 1.19; 95% CI: 0.99-1.44, p=0.06, I2=0%) and the risk of total major and minor bleeding (Pooled RR: 1.30; 95% CI: 1.15-1.48, p<0.0001, I2=0%).Prasugrel has similar effects as clopidogrel in terms of all causes of death, MI, and stroke in ACS patients.However, prasugrel is associated with significantly higher risk of bleeding.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiovascular Medicine, Zaozhuang Municipal Hospital, Zaozhuang, Shandong, China (mainland).

ABSTRACT

Background: Whether prasugrel can take the place of clopidogrel for patients with acute coronary syndrome (ACS) is not clear. The aim of this study was to perform a meta-analysis for systematically reviewing the evidence on prasugrel in comparison to clopidogrel in patients with ACS.

Material/methods: Relevant prospective and retrospective studies were searched in databases. Six studies were finally included. Pooled risk ratios (RRs) and 95% confidence intervals (CIs) were calculated to assess all causes of death, myocardial infarction (MI), stroke, major bleeding, major/minor bleeding, and stent thrombosis (for PCI performed).

Results: Compared with clopidogrel, prasugrel had similar risks of all cause of death (Pooled RR: 0.83; 95% CI: 0.64-1.06, p=0.14, I2=55%), MI (Pooled RR: 0.86; 95% CI: 0.71-1.04, p=0.12) and stroke (pooled RR: 0.88; 95% CI: 0.70-1.10, p=0.25). However, prasugrel was associated with significantly higher risk of both major bleeding (Pooled RR: 1.19; 95% CI: 0.99-1.44, p=0.06, I2=0%) and the risk of total major and minor bleeding (Pooled RR: 1.30; 95% CI: 1.15-1.48, p<0.0001, I2=0%). For the patients who underwent percutaneous coronary intervention (PCI), prasugrel was associated with significantly lower risk of stent thrombosis (Pooled RR: 0.47; 95% CI: 0.34-0.61, p<0.00001, I2=0%).

Conclusions: Prasugrel has similar effects as clopidogrel in terms of all causes of death, MI, and stroke in ACS patients. For the patients who underwent PCI, prasugrel contributes to lower risk of stent thrombosis. However, prasugrel is associated with significantly higher risk of bleeding. For the patients with active pathological bleeding or a history of stroke and/or TIA, prasugrel should not be recommended.

No MeSH data available.


Related in: MedlinePlus

Flow chart of searching and screening process.
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f1-medscimonit-21-1131: Flow chart of searching and screening process.

Mentions: The systematic search found 54 studies of potential interest. Among them, 6 were excluded because the full text was not in English; 25 were excluded because they did not meet the inclusion criteria; and 10 reviews, 5 duplicate studies, and 2 meta-analyses were excluded. The process of screening potential studies for inclusion is summarized in a flow chart in Figure 1. As shown in Table 1, a total of 6 studies were finally included in the meta-analysis [11,18–22]. Some of the selected characteristics of the included RCTs are shown in Table 1. Among the 6 studies, five5 are prospective [11,18–21] and 1 is retrospective [22]. A total of 29 041 patients were involved in this study. The follow-up period ranged from 1 month to a median of 17.1 months in the 6 studies.


Novel oral P2Y12 inhibitor prasugrel vs. clopidogrel in patients with acute coronary syndrome: evidence based on 6 studies.

Jia M, Li Z, Chu H, Li L, Chen K - Med. Sci. Monit. (2015)

Flow chart of searching and screening process.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4548705&req=5

f1-medscimonit-21-1131: Flow chart of searching and screening process.
Mentions: The systematic search found 54 studies of potential interest. Among them, 6 were excluded because the full text was not in English; 25 were excluded because they did not meet the inclusion criteria; and 10 reviews, 5 duplicate studies, and 2 meta-analyses were excluded. The process of screening potential studies for inclusion is summarized in a flow chart in Figure 1. As shown in Table 1, a total of 6 studies were finally included in the meta-analysis [11,18–22]. Some of the selected characteristics of the included RCTs are shown in Table 1. Among the 6 studies, five5 are prospective [11,18–21] and 1 is retrospective [22]. A total of 29 041 patients were involved in this study. The follow-up period ranged from 1 month to a median of 17.1 months in the 6 studies.

Bottom Line: However, prasugrel was associated with significantly higher risk of both major bleeding (Pooled RR: 1.19; 95% CI: 0.99-1.44, p=0.06, I2=0%) and the risk of total major and minor bleeding (Pooled RR: 1.30; 95% CI: 1.15-1.48, p<0.0001, I2=0%).Prasugrel has similar effects as clopidogrel in terms of all causes of death, MI, and stroke in ACS patients.However, prasugrel is associated with significantly higher risk of bleeding.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiovascular Medicine, Zaozhuang Municipal Hospital, Zaozhuang, Shandong, China (mainland).

ABSTRACT

Background: Whether prasugrel can take the place of clopidogrel for patients with acute coronary syndrome (ACS) is not clear. The aim of this study was to perform a meta-analysis for systematically reviewing the evidence on prasugrel in comparison to clopidogrel in patients with ACS.

Material/methods: Relevant prospective and retrospective studies were searched in databases. Six studies were finally included. Pooled risk ratios (RRs) and 95% confidence intervals (CIs) were calculated to assess all causes of death, myocardial infarction (MI), stroke, major bleeding, major/minor bleeding, and stent thrombosis (for PCI performed).

Results: Compared with clopidogrel, prasugrel had similar risks of all cause of death (Pooled RR: 0.83; 95% CI: 0.64-1.06, p=0.14, I2=55%), MI (Pooled RR: 0.86; 95% CI: 0.71-1.04, p=0.12) and stroke (pooled RR: 0.88; 95% CI: 0.70-1.10, p=0.25). However, prasugrel was associated with significantly higher risk of both major bleeding (Pooled RR: 1.19; 95% CI: 0.99-1.44, p=0.06, I2=0%) and the risk of total major and minor bleeding (Pooled RR: 1.30; 95% CI: 1.15-1.48, p<0.0001, I2=0%). For the patients who underwent percutaneous coronary intervention (PCI), prasugrel was associated with significantly lower risk of stent thrombosis (Pooled RR: 0.47; 95% CI: 0.34-0.61, p<0.00001, I2=0%).

Conclusions: Prasugrel has similar effects as clopidogrel in terms of all causes of death, MI, and stroke in ACS patients. For the patients who underwent PCI, prasugrel contributes to lower risk of stent thrombosis. However, prasugrel is associated with significantly higher risk of bleeding. For the patients with active pathological bleeding or a history of stroke and/or TIA, prasugrel should not be recommended.

No MeSH data available.


Related in: MedlinePlus