Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2024 Feb 10:51:101359.
doi: 10.1016/j.ijcha.2024.101359. eCollection 2024 Apr.

Comprehensive comparative efficacy and safety of potent P2Y12 inhibitors in patients undergoing coronary intervention: A systematic review and meta-analysis

Chien-Lung Huang  1 , Tien-Ping Tsao  1   2 , Wei-Hsian Yin  1   3 , Wen-Bin Huang  1 , Hsu-Lung Jen  1 , Chang-Chyi Lin  1 , Chung-Yi Chang  4 , Ching-Hwa Hsu  5
Affiliations
Review

Comprehensive comparative efficacy and safety of potent P2Y12 inhibitors in patients undergoing coronary intervention: A systematic review and meta-analysis

Chien-Lung Huang et al. Int J Cardiol Heart Vasc. .

Abstract

Potent P2Y12 receptor antagonists have been used widely for patients undergoing percutaneous coronary intervention with different results. Benefits from different regimens various between trials. Randomized controlled trials (RCTs) have restrictive inclusion and exclusion criteria; thus, they may limit the generalizability of the findings to a broader population. This study was aimed to comprehensively investigate the outcomes of potent P2Y12 inhibitors in patients undergoing PCI, including RCTs and real-world evidence (RWE) studies. Multiple electronic databases were systemically reviewed and searched on compared potent P2Y12 inhibitors with clopidogrel. The primary efficacy end point was composite ischemic cardiovascular event and primary safety endpoint was major bleeding. Overall estimates of proportions and incidence rates with 95 % confidence intervals (CI) were calculated using fixed-effects models. Total 24 studies (140,986 patients) underwent coronary intervention were included in this meta-analysis, including 18 RCTs and 6 large cohort studies with propensity score matching. The potent P2Y12 inhibitors including cangrelor, prasugrel, and ticagrelor, significantly decreased the risk of composite adverse cardiovascular ischemic events (95 % CI 0.89-0.96, p < 0.001), but increased major bleeding (95 % CI 1.15-1.33, p < 0.001) or any bleeding (95 % CI 1.21-1.33, p < 0.001) compared with Clopidogrel. This meta-analysis merges RCTs and RWE studies and comprehensively evidences newer potent P2Y12 inhibitors are significantly more effective than clopidogrel in reduction of composite adverse thrombotic events, but the incidence of major or any bleeding was higher compared with clopidogrel.

Keywords: Coronary intervention; Potent P2Y12 inhibitor; Randomized control trial; Real-world evidence.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram of study selection.
Fig. 2
Fig. 2
Effectiveness and safety of individual potent P2Y12 inhibitors (cangrelor, prasugrel, and ticagrelor) vs. clopidogrel by pooled odds ratios and 95% CIs. CI= confidence interval. CV= cardiovascular.
Fig. 3
Fig. 3
Meta-analysis of the primary efficacy end point of composite thrombotic cardiovascular events.
Fig. 4
Fig. 4
Meta-analysis of the primary safety end point of major bleeding.
Fig. 5
Fig. 5
Meta-analysis of the safety end point of any bleeding.
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Chen Z.M., Jiang L.X., Chen Y.P., et al. Addition of clopidogrel to aspirin in 45,852 patients with acute myocardial infarction: randomised placebo-controlled trial. The Lancet. 2005;366(9497):1607–1621. doi: 10.1016/s0140-6736(05)67660-x. - DOI - PubMed
    1. Steinhubl S.R., Oh J.J., Oestreich J.H., Ferraris S., Charnigo R., Akers W.S. Transitioning patients from cangrelor to clopidogrel: pharmacodynamic evidence of a competitive effect. Thrombosis Research. 2008;121(4):527–534. doi: 10.1016/j.thromres.2007.05.020. - DOI - PubMed
    1. Wallentin L., Varenhorst C., James S., et al. Prasugrel achieves greater and faster P2Y12receptor-mediated platelet inhibition than clopidogrel due to more efficient generation of its active metabolite in aspirin-treated patients with coronary artery disease. European Heart Journal. 2008;29(1):21–30. doi: 10.1093/eurheartj/ehm545. - DOI - PubMed
    1. Wallentin L., Becker R.C., Budaj A., et al. Ticagrelor versus clopidogrel in patients with acute coronary syndromes. New England Journal of Medicine. 2009;361(11):1045–1057. doi: 10.1056/NEJMoa0904327. - DOI - PubMed
    1. Cannon C.P., Harrington R.A., James S., et al. Comparison of ticagrelor with clopidogrel in patients with a planned invasive strategy for acute coronary syndromes (PLATO): a randomised double-blind study. The Lancet. 2010;375(9711):283–293. doi: 10.1016/S0140-6736(09)62191-7. - DOI - PubMed

LinkOut - more resources