In:
Journal of Cardiovascular Pharmacology, Ovid Technologies (Wolters Kluwer Health), Vol. 69, No. 3 ( 2017-03), p. 147-155
Abstract:
New P2Y 12 adenosine diphosphate receptor antagonists have been used in the treatment of acute coronary syndrome (ACS) with different results. This systematic review analyzed and compared the evidence from large, clinical trials regarding the efficacy of clopidogrel relative to that of cangrelor, prasugrel, and ticagrelor in reducing the incidence of cardiovascular events in patients with ACS. Methods and Results: This analysis compared newer P2Y 12 inhibitors with clopidogrel of 13 clinical trials involved a total of 87,985 patients with ACS. The newer P2Y 12 inhibitors include cangrelor, prasugrel, and ticagrelor. Newer P2Y 12 inhibitors significantly decreased the risk of myocardial infarction and showed a trend toward reduction of cardiovascular death (odds ratio [OR] = 0.86, 95% confidence interval [CI] , 0.77–0.96, and I 2 = 54%, P 〈 0.05); (OR = 0.85, 95% CI, 0.77–0.93, and I 2 = 42%, P 〈 0.001). The rates of stroke events and the incidence in patients with ACS did not differ statistically between the clopidogrel group and the group with newer P2Y 12 inhibitors (OR = 0.95, 95% CI, 0.79–1.14, and I 2 = 0%, P = 0.57). However, newer P2Y 12 inhibitors showed a significant increase in thrombosis in MI major or minor bleeding (OR = 1.21, 95% CI, 1.03–1.42, and I 2 = 56%, P = 0.02) compared with clopidogrel. Conclusions: Based on this meta-analysis, newer P2Y 12 inhibitors were significantly more effective than clopidogrel in the events of myocardial infarction and cardiovascular death in patients with ACS, although the incidence of thrombosis in MI-defined bleeding was higher compared with clopidogrel.
Type of Medium:
Online Resource
ISSN:
0160-2446
DOI:
10.1097/FJC.0000000000000451
Language:
English
Publisher:
Ovid Technologies (Wolters Kluwer Health)
Publication Date:
2017
detail.hit.zdb_id:
2049700-3
SSG:
15,3
