Comparison of platelet reactivity between prasugrel and ticagrelor in patients with acute coronary syndrome: a meta-anal
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RESEARCH ARTICLE
Open Access
Comparison of platelet reactivity between prasugrel and ticagrelor in patients with acute coronary syndrome: a meta-analysis Mingxiang Wen1*† , Yaqi Li2†, Xiang Qu2†, Yanyan Zhu3, Lingfang Tian4, Zhongqin Shen4, Xiulin Yang2 and Xianqing Shi1*
Abstract Background: This meta-analysis aimed to compare the effects of prasugrel and ticagrelor on high (HTPR) and low on-treatment platelet reactivity (LTPR) in patients with acute coronary syndrome (ACS). Methods: Eligible studies were retrieved from PubMed, Embase, and the Cochrane Library. HTPR and LTPR were evaluated on the basis of the vasodilator-stimulated phosphoprotein platelet reactivity index (VASP-PRI) and P2Y12 reaction units (PRUs). HTPR and LTPR were analyzed using risk ratios (RRs) and their 95% confidence intervals (CIs). Weighted mean difference (WMD) and 95% CI were used to calculate the pooled effect size of platelet reactivity (PR). Results: Fourteen eligible studies were obtained, which included 2629 patients treated with ticagrelor (n = 1340) and prasugrel (n = 1289). The pooled results showed that the prasugrel-treated patients had higher platelet reactivity than the ticagrelor-treated patients (PRU: WMD = − 32.26; 95% CI: − 56.48 to − 8.76; P < 0.01; VASP-PRI: WMD = − 9.61; 95% CI: − 14.63 to − 4.60; P = 0.002). No significant difference in HTPR based on PRU was identified between the ticagrelor and prasugrel groups (P = 0.71), whereas a lower HTPR based on VASP-PRI was found in the ticagrelor-treated patients than in the prasugrel-treated patients (RR = 0.30; 95% CI: 0.12–0.75; P = 0.010). In addition, the results showed a lower LTPR was observed in the prasugrel group than in the ticagrelor group (RR = 1.40; 95% CI: 1.08–1.81; P = 0.01). Conclusions: Prasugrel might enable higher platelet reactivity than ticagrelor. Ticagrelor could lead to a decrease in HTPR and increase in LTPR. However, this result was only obtained in pooled observational studies. Several uncertainties such as the nondeterminancy of the effectiveness of ticagrelor estimated using VASP-PRI or the definition of HTPR (a high or modifiable risk factor) might have affected our results. Keywords: Ticagrelor, Prasugrel, Acute coronary syndrome, Meta-analysis
Background Acute coronary syndrome (ACS), a common but serious type of coronary artery disease [1], is characterized by primary atherosclerotic plaque rupture and secondary completely or partially occlusive thrombus that leads to * Correspondence: [email protected]; [email protected] † Mingxiang Wen, Yaqi Li and Xiang Qu contributed equally to this work. † Mingxiang Wen and Yaqi Li are co-first authors. 1 Intensive Care Unit, Guizhou Provincial People’s Hospital, No. 58 Zhongshan East Road, Nanming District, Guiyang 550002, Guizhou, China Full list of author information is available at the end of the article
ST-segment elevation myocardial infarction (STEMI), non-STEMI (NSTEMI), and unstable angina [2]. Percutaneous coronary intervention (PCI) is considered the preferred treatment for ACS to
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