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. 2018 Dec 8:22:39-45.
doi: 10.1016/j.ijcha.2018.11.008. eCollection 2019 Mar.

Short term outcome following acute phase switch among P2Y12 inhibitors in patients presenting with acute coronary syndrome treated with PCI: A systematic review and meta-analysis including 22,500 patients from 14 studies

Enrico Cerrato  1 , Matteo Bianco  2 , Akshay Bagai  3 , Leonardo De Luca  4 , Simone Biscaglia  5 , Alessia Luciano  2 , Paola Destefanis  2 , Giorgio Quadri  1 , Ilaria Meynet  6 , Carol Gravinese  2 , Alessandra Chinaglia  7 , Shaun G Goodman  3 , Roberto Pozzi  2 , Gianluca Campo  5 , Ferdinando Varbella  1
Affiliations

Short term outcome following acute phase switch among P2Y12 inhibitors in patients presenting with acute coronary syndrome treated with PCI: A systematic review and meta-analysis including 22,500 patients from 14 studies

Enrico Cerrato et al. Int J Cardiol Heart Vasc. .

Erratum in

Abstract

Introduction: The efficacy and safety of switching P2Y12 receptor antagonists in patients admitted for acute coronary syndrome (ACS) remain unclear. We assessed the short-term clinical outcomes (in-hospital and within 30 days) of switching P2Y12 inhibitor (P2Y12I) drugs versus maintaining the same regimen by performing a comprehensive review and meta-analysis of available data.

Methods: MEDLINE/PubMed/SCOPUS/Cochrane databases were screened for studies regarding switching of P2Y12I in patients with ACS that reported 30 days follow-up. Major cardiac events (MACE) and bleeding were compared between patients who were switched/not switched.

Results: 22,500 patients from 14 studies were included. Unstable angina/non-ST elevation myocardial infarction (62.0%, interquartile range, 52.8%-68.0%) was the most common clinical presentation. The total number switched was 4294 (19.1%); escalation in 3416 (79.5%) patients (from clopidogrel to prasugrel, 62.9%) and de-escalation in 18.5%. Pooled analysis revealed no significant differences in MACE for any comparison; risk of bleeding was significantly increased among switched patients overall (odds ratio [OR], 1.60; 95% confidence interval [CI] 1.22-2.10) and increased in the escalation group (OR, 1.51; 95% CI, 1.06-2.16).

Conclusions: Among patients presenting with ACS, switching from one P2Y12I agent to another in the acute phase seems associated with a short-term increased risk of bleeding. Accurate upfront selection and prescription of a P2Y12I based on ischemic and bleeding risks is paramount to avoid adverse events switching-related during hospitalization and in the first 30 days.

Keywords: Acute coronary syndrome; Clopidogrel; Novel P2Y12 inhibitors; Prasugrel; Switching; Ticagrelor.

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Figures

Fig. 1
Fig. 1
Overview of the review. CAD, coronary artery disease.
Fig. 2
Fig. 2
(A) Meta-analysis of MACE in patients undergoing any type of switch among P2Y12 drugs versus maintaining the same regimen. (B) Meta-analysis of MACE in patients undergoing an escalation from clopidogrel/ticlopidine to a novel P2Y12 versus maintaining the same regimen. (C) Meta-analysis of MACE in patients undergoing a de-escalation from a novel P2Y12 to clopidogrel versus maintaining the same regimen.
Fig. 3
Fig. 3
(A) Meta-analysis of bleeding in patients undergoing any type of switch among P2Y12 drugs versus maintaining the same regimen. (B) Meta-analysis of bleeding in patients undergoing an escalation from clopidogrel/ticlopidine to a novel P2Y12 versus maintaining the same regimen. (C) Meta-analysis of bleeding in patients undergoing a de-escalation from a novel P2Y12 to clopidogrel versus maintaining the same regimen.
Online Fig. A
Online Fig. A
A funnel plot referred to overall MACE.
Online Fig. B
Online Fig. B
A funnel plot referred to overall bleedings.
See this image and copyright information in PMC

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