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Review
. 2023 Jun 10;15(6):e40211.
doi: 10.7759/cureus.40211. eCollection 2023 Jun.

Ticagrelor Versus Clopidogrel in Patients With Acute Coronary Syndrome and on Dialysis: A Meta-Analysis

Venkata Sai Harshabhargav Chenna  1 , Hemalatha Anam  2 , Majid Hassan  3 , Abdul Moeez  4 , Raja Reddy  5 , Sandipkumar S Chaudhari  6   7 , Koushik Sapkota  8 , Muhammad Usama  9
Affiliations
Review

Ticagrelor Versus Clopidogrel in Patients With Acute Coronary Syndrome and on Dialysis: A Meta-Analysis

Venkata Sai Harshabhargav Chenna et al. Cureus. .

Abstract

This study aims to compare the safety and efficacy of clopidogrel and ticagrelor in patients with acute coronary syndrome (ACS) and undergoing dialysis. This study was conducted per the guidelines of the Preferred Reporting of Systematic Reviews and Meta-Analyses (PRISMA). A comprehensive search was performed using electronic databases, including PubMed, EMBASE, and Web of Science, to identify relevant studies comparing clopidogrel and ticagrelor in patients undergoing dialysis. To ensure the inclusion of all relevant articles, a combination of the following keywords, along with medical subject heading (MeSH) terms, was used: "clopidogrel," "ticagrelor," "acute coronary syndrome," and "dialysis." The primary endpoint of this meta-analysis was the incidence of major adverse cardiovascular events (MACE), which consisted of cardiovascular death, myocardial infarction, stroke, and revascularization. The secondary endpoint was all-cause mortality. The occurrence of any bleeding events (including major and nonmajor bleeding events) and major bleeding events was chosen as the safety endpoints. A total of four studies were included in the pooled analysis. The pooled sample size was 5,417 patients, including 892 in the ticagrelor group and 4525 in the clopidogrel group. The findings indicate that ticagrelor, compared to clopidogrel, is associated with a significantly higher risk of MACEs, all-cause death, and major bleeding events. The findings suggest that clopidogrel may be a better choice for individuals with ACS undergoing dialysis due to its lower risk of MACE, all-cause death, and major bleeding events compared to ticagrelor.

Keywords: acute coronary syndrome; clopidogrel; dialysis; efficacy; ticagrelor.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. PRISMA flowchart of study selection.
PRISMA, Preferred Reporting of Systematic Reviews and Meta-Analyses
Figure 2
Figure 2. Major adverse cardiovascular events.
Sources: [18-21]. CI, confidence interval; SE, standard error
Figure 3
Figure 3. All-cause death.
Sources: [19-21]. CI, confidence interval; SE, standard error
Figure 4
Figure 4. Bleeding events.
Sources: [18-21]. CI, confidence interval; SE, standard error
Figure 5
Figure 5. Major bleeding events.
Sources: [19-21]. CI, confidence interval; SE, standard error
See this image and copyright information in PMC

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