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Efficacy and Safety of Potent Oral P2Y12 Inhibitors in Medically Managed ACS Patients: a Meta-analysis

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Abstract

Purpose

Although current guidelines recommend ticagrelor in addition to aspirin as the antiplatelet strategy for medically managed acute coronary syndrome (MMACS) patients, clinical evidence specific to this special population is lacking. Whether potent oral P2Y12 inhibitors should be used in MMACS patients is still under debate.

Methods

We conducted a comprehensive search in PubMed, Embase, Web of Science, and Cochrane Library to identify studies exploring the efficacy or safety of ticagrelor and prasugrel versus clopidogrel or placebo in MMACS patients. The primary efficacy endpoint was major adverse cardiovascular events (MACE) defined by each study, and the safety endpoint was TIMI non-CABG major bleeding.

Results

A total of 6102 records were screened, and 4 studies including 46,346 patients were finally included. The use of potent oral P2Y12 inhibitors significantly lowers the risk of MACE compared with clopidogrel (HR: 0.90; 95% CI: 0.82–0.98; P = .018; I2 = 0%). A significant reduction in risks of all-cause death and myocardial infarction was also observed with the use of potent oral P2Y12 inhibitors compared with clopidogrel. No significant difference in risks of stroke or TIMI non-CABG major bleeding (HR: 1.24; 95% CI: 0.90–1.73; P = .191; I2 = 0%) was observed between potent oral P2Y12 inhibitors and clopidogrel.

Conclusion

Potent oral P2Y12 inhibitors, especially ticagrelor, decrease the risk of ischemic events in MMACS patients as compared with clopidogrel, without significantly increasing major bleeding.

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Authors and Affiliations

  1. The Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, Liaoning Province, China

    Sicong Ma, Zhiguo Li, Haixu Song, Zaixin Jiang, Yi Li & Yaling Han

  2. The Department of Cardiology, Xijing Hospital, Fourth Military Medical University, Xi’an, Shanxi Province, China

    Sicong Ma & Peng Yu

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  1. Sicong Ma
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Correspondence to Yi Li or Yaling Han.

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Ma, S., Li, Z., Yu, P. et al. Efficacy and Safety of Potent Oral P2Y12 Inhibitors in Medically Managed ACS Patients: a Meta-analysis. Cardiovasc Drugs Ther 34, 199–208 (2020). https://doi.org/10.1007/s10557-020-06940-y

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