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. 2001;2001(4):CD002133.
doi: 10.1002/14651858.CD002133.

Ticlopidine versus oral anticoagulation for coronary stenting

B Cosmi  1 , A Rubboli, C Castelvetri, M Milandri
Affiliations

Ticlopidine versus oral anticoagulation for coronary stenting

B Cosmi et al. Cochrane Database Syst Rev. 2001.

Abstract

Background: A 2-4 week course of ticlopidine plus aspirin following coronary stenting is considered effective in preventing thrombotic occlusion of the stented vessel and safe in regards to bleeding and peripheral vascular complications. However, rare, although potentially life-threatening haematological complications have been reported with this drug regimen.

Objectives: To evaluate the efficacy and safety of ticlopidine plus aspirin versus oral anticoagulants after coronary stenting

Search strategy: Electronic search of the Cochrane Library, Medline, Embase from 1991 to June 1999; references from trials and experts.

Selection criteria: Randomised controlled trials comparing ticlopidine plus aspirin versus oral anticoagulants (either with or without aspirin) after elective or bail out coronary stenting.

Data collection and analysis: Three reviewers assessed trial quality and compiled data on outcomes including: total mortality, non fatal myocardial infarction and revascularization occurring within the first 30 days after hospitalization, stent thrombosis on angiography, major and minor bleeding, neutropenia, thrombocytopenia, thrombotic thrombocytopenic purpura.

Main results: Four trials (n=2436 patients) were included. Ticlopidine plus aspirin compared to oral anticoagulants significantly reduced the risk of non-fatal acute myocardial infarction and revascularization at 30 days, combined negative events (mortality, myocardial infarction, revascularization at 30 days) (RR: 0.41; 95% CI: 0.25-0.69; NNT for 30 days: 22; 95% CI: 14-45), and major bleeding (RR in high quality studies: 0.24; 95% CI: 0.07-0.79). Ticlopidine plus aspirin compared to oral anticoagulants significantly increased the risk of eutropenia, thrombocytopenia and neutropenia (RR 5; 95% CI: 1.08-13.07; NNT for 30 days: 142; 95% CI: 76-1000). Ticlopidine plus aspirin vs oral anticoagulation did not affect all cause mortality. Ticlopidine plus aspirin significantly reduced the risk of stent thrombosis (angiography) which was seen only on studies with blinded outcome assessment (RR: 0.14; 95% CI: 0.03-0.60; NNT for 30 days: 33; 95% CI:16-166). Minor bleeding was reported only in one study and no studies recorded thrombotic thrombocytopenic purpura (TTP).

Reviewer's conclusions: Ticlopidine plus aspirin after coronary stenting is effective in reducing the risk of the revascularization, non fatal myocardial infarction and bleeding complications when compared with oral anticoagulants. No effect is observed on total mortality. However, the haematological side effects of ticlopidine are still a matter of concern, and strict monitoring of blood-cell counts is recommended. Physicians should also be aware of the possibility of rare although potentially life-threatening complications such as TTP

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Conflict of interest statement

There is no known conflict of interest.

Figures

1.1
1.1. Analysis
Comparison 1 total mortality, Outcome 1 total mortality.
2.1
2.1. Analysis
Comparison 2 non fatal myocardial infarction, Outcome 1 non fatal myocardial infarction.
2.2
2.2. Analysis
Comparison 2 non fatal myocardial infarction, Outcome 2 non‐fatal AMI in Jadad score 3 studies.
2.3
2.3. Analysis
Comparison 2 non fatal myocardial infarction, Outcome 3 non fatal AMI in Jadad score <3 studies.
3.1
3.1. Analysis
Comparison 3 revascularization within 30 days, Outcome 1 revascularization within 30 days.
3.2
3.2. Analysis
Comparison 3 revascularization within 30 days, Outcome 2 revascularization within 30 days Jadad score 3.
3.3
3.3. Analysis
Comparison 3 revascularization within 30 days, Outcome 3 revascularization within 30 days Jadad score<3.
4.1
4.1. Analysis
Comparison 4 total primary outcome, Outcome 1 total primary outcome.
4.2
4.2. Analysis
Comparison 4 total primary outcome, Outcome 2 total primary outcome Jadad score 3.
4.3
4.3. Analysis
Comparison 4 total primary outcome, Outcome 3 total primary outcome Jadad score<3.
5.1
5.1. Analysis
Comparison 5 stent thrombosis on angiography, Outcome 1 stent thrombosis on angiography.
5.2
5.2. Analysis
Comparison 5 stent thrombosis on angiography, Outcome 2 stent thrombosis on angiography Jadad score 3.
5.3
5.3. Analysis
Comparison 5 stent thrombosis on angiography, Outcome 3 stent thrombosis on angiography Jadad score<3.
5.4
5.4. Analysis
Comparison 5 stent thrombosis on angiography, Outcome 4 stent thrombosis on angiography Fantastic+Stars.
6.1
6.1. Analysis
Comparison 6 major bleeding, Outcome 1 major bleeding.
6.2
6.2. Analysis
Comparison 6 major bleeding, Outcome 2 major bleeding Jadad score 3.
6.3
6.3. Analysis
Comparison 6 major bleeding, Outcome 3 major bleeding Jadad score <3.
7.1
7.1. Analysis
Comparison 7 minor bleeding, Outcome 1 minor bleeding.
8.1
8.1. Analysis
Comparison 8 neutropenia/leukopenia/thrombocytopenia, Outcome 1 neutropenia/leukopenia/thrombocytopenia.
8.2
8.2. Analysis
Comparison 8 neutropenia/leukopenia/thrombocytopenia, Outcome 2 Jadad score 3.
8.3
8.3. Analysis
Comparison 8 neutropenia/leukopenia/thrombocytopenia, Outcome 3 Jadad score <3.
9.1
9.1. Analysis
Comparison 9 vascular access site bleeding, Outcome 1 local bleeding complications (total).
9.2
9.2. Analysis
Comparison 9 vascular access site bleeding, Outcome 2 vascular access site bleeding ( no ecchymosis).
9.3
9.3. Analysis
Comparison 9 vascular access site bleeding, Outcome 3 total Jadad score > 3.
10.1
10.1. Analysis
Comparison 10 total primary outcome in elective versus unplanned stenting, Outcome 1 elective stenting.
10.2
10.2. Analysis
Comparison 10 total primary outcome in elective versus unplanned stenting, Outcome 2 unplanned stenting.
See this image and copyright information in PMC

References

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