Limits...
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: 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%).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

Comparison of death/MI/Stroke between prasugrel and clopidogrel. (A) Comparison of death between prasugrel and clopidogrel. (B) Comparison of MI between prasugrel and clopidogrel. (C) Comparison of Stroke between prasugrel and clopidogrel.
© Copyright Policy
Related In: Results  -  Collection


getmorefigures.php?uid=PMC4548705&req=5

f2-medscimonit-21-1131: Comparison of death/MI/Stroke between prasugrel and clopidogrel. (A) Comparison of death between prasugrel and clopidogrel. (B) Comparison of MI between prasugrel and clopidogrel. (C) Comparison of Stroke between prasugrel and clopidogrel.

Mentions: Generally, the patients who received prasugrel had similar risks of all causes of death (630/14,626, 4.31%) compared those who took clopidogrel (708/10 414, 6.80%) (Pooled RR: 0.83; 95% CI: 0.64–1.06, p=0.14, I2=55%) (Figure 2A). However, the retrospective study found prasugrel contributed to lower risk of death (pooled RR: 0.57; 95% CI: 0.39–0.83, p=0.004), but the effect was not observed in prospective studies (pooled RR: 0.93; 95% CI: 0.76–1.13, p=0.47, I2=56%) (Figure 2A). Prasugrel was associated with similar risk of MI as clopidogrel (884/14 440, 6.12% vs. 1028/14,086, 7.30%) (Pooled RR: 0.86; 95% CI: 0.71–1.04, p=0.12) (Figure 2B). No significant difference was observed in subgroup analysis (p=0.52, I2=0%) (Figure 2B). The risk of stroke was also similar in both prasugrel and clopidogrel group (143/14 626, 0.98% vs. 173/14,414, 1.20%) (Pooled RR: 0.88; 95% CI: 0.70–1.10, p=0.25, I2=0%) (Figure 2C). No significant difference was observed in subgroup analysis (p=0.95, I2=0%) (Figure 2C).


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)

Comparison of death/MI/Stroke between prasugrel and clopidogrel. (A) Comparison of death between prasugrel and clopidogrel. (B) Comparison of MI between prasugrel and clopidogrel. (C) Comparison of Stroke between prasugrel and clopidogrel.
© Copyright Policy
Related In: Results  -  Collection

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

f2-medscimonit-21-1131: Comparison of death/MI/Stroke between prasugrel and clopidogrel. (A) Comparison of death between prasugrel and clopidogrel. (B) Comparison of MI between prasugrel and clopidogrel. (C) Comparison of Stroke between prasugrel and clopidogrel.
Mentions: Generally, the patients who received prasugrel had similar risks of all causes of death (630/14,626, 4.31%) compared those who took clopidogrel (708/10 414, 6.80%) (Pooled RR: 0.83; 95% CI: 0.64–1.06, p=0.14, I2=55%) (Figure 2A). However, the retrospective study found prasugrel contributed to lower risk of death (pooled RR: 0.57; 95% CI: 0.39–0.83, p=0.004), but the effect was not observed in prospective studies (pooled RR: 0.93; 95% CI: 0.76–1.13, p=0.47, I2=56%) (Figure 2A). Prasugrel was associated with similar risk of MI as clopidogrel (884/14 440, 6.12% vs. 1028/14,086, 7.30%) (Pooled RR: 0.86; 95% CI: 0.71–1.04, p=0.12) (Figure 2B). No significant difference was observed in subgroup analysis (p=0.52, I2=0%) (Figure 2B). The risk of stroke was also similar in both prasugrel and clopidogrel group (143/14 626, 0.98% vs. 173/14,414, 1.20%) (Pooled RR: 0.88; 95% CI: 0.70–1.10, p=0.25, I2=0%) (Figure 2C). No significant difference was observed in subgroup analysis (p=0.95, I2=0%) (Figure 2C).

Bottom Line: 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%).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