Prasugrel Versus Ticagrelor in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention: a Sy
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ORIGINAL ARTICLE
Prasugrel Versus Ticagrelor in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention: a Systematic Review and Meta-analysis of Randomized Trials Avik Ray 1
&
Ahmad Najmi 1 & Gaurav Khandelwal 2 & Ratinder Jhaj 1 & Balakrishnan Sadasivam 1
Accepted: 13 August 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose Dual antiplatelet therapy (DAPT) with aspirin and ticagrelor or prasugrel is the mainstay of treatment for patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). We aimed to systematically perform a head-to-head comparison of ticagrelor vs prasugrel in terms of efficacy and safety. Methods We searched PubMed/Medline, EMBASE and Cochrane Central Register of Controlled Trials (CENTRAL) for relevant published randomized controlled trials (RCTs). The primary outcome was adverse cardiovascular events and secondary outcome was bleeding events. A random-effects meta-analysis was used to obtain the pooled estimate of each outcome. Results Nine RCTs with a total number of 6990 patients (3550 treated with prasugrel and 3481 treated with ticagrelor) were included. No significant difference between prasugrel and ticagrelor was observed in terms of mortality (OR 0.86, 95% CI 0.66 to 1.13, P = 0.28), major adverse cardiovascular events (MACEs) (OR 0.85, 95% CI 0.70 to 1.03, P = 0.10), non-fatal myocardial infarction (OR 0.78, 95% CI 0.57 to 1.06, P = 0.11), stroke (OR 1.02, 95% CI 0.60 to 1.72, P = 0.95), stent thrombosis (OR 0.76, 95% CI 0.47 to 1.21, P = 0.25), thrombolysis in myocardial infarction (TIMI) defined major (OR 0.94, 95% CI 0.19 to 4.67, P = 0.94), minor (OR 0.35, 95% CI 0.08 to 1.62, P = 0.18) and minimal (OR 0.48, 95% CI 0.19 to 1.18, P = 0.11) bleeding and Bleeding Academic Research Consortium (BARC) defined bleeding (OR 1.06, 95% CI 0.82 to 1.36, P = 0.68). Conclusion In patients with ACS undergoing PCI, both prasugrel and ticagrelor were associated with similar cardiovascular outcomes and adverse bleeding events. Keywords Acute coronary syndrome . Prasugrel . Percutaneous coronary intervention . Ticagrelor . Meta-analysis
Introduction Dual antiplatelet therapy (DAPT) with aspirin and an oral P2Y12 receptor antagonist is the recommended gold standard treatment for patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) [1, 2]. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10557-020-07056-z) contains supplementary material, which is available to authorized users. * Avik Ray [email protected] 1
Department of Pharmacology, All India Institute of Medical Sciences Bhopal, Bhopal, Madhya Pradesh 462020, India
2
Department of Cardiology, All India Institute of Medical Sciences Bhopal, Bhopal, Madhya Pradesh 462020, India
The current updated guidelines recommend the use of ticagrelor or prasugrel, the newer oral P2Y12 receptor antagonists, instead of clopidogrel in view of i
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