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Comparison of new adenosine diphosphate receptor antagonists with clopidogrel in patients with coronary artery disease: a meta-analysis

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Abstract

Recent data suggest the superiority of new adenosine diphosphate (ADP) receptor antagonists compared with clopidogrel in acute coronary syndrome patients. We aimed to assess the risks and benefits of new ADP receptor antagonists in patients with coronary artery disease (CAD). Relevant studies published through February 28, 2014 were searched and identified in the MEDLINE, EMBASE, and Cochrane databases. Summary estimates were obtained using a random-effects model. All nine published randomized controlled studies comparing new ADP receptor antagonists with clopidogrel in CAD were included. The database consisted of 66,900 patients; 33,782 on novel agents, and 33,118 on clopidogrel. New ADP receptor antagonists reduced the composite incidence of all-cause mortality, myocardial infarction or stroke (odds ratio [OR] 0.89, 95 % confidence interval [CI] 0.81–0.97, p = 0.01) but increased the incidence of non-coronary artery bypass grafting-related major bleeding (OR 1.24, 95 % CI 1.08–1.42, p = 0.003). The composite end point of the net rate of adverse clinical events, which was the combination of the primary efficacy end point and the primary safety end point, was significantly lower in the new agent group compared to the clopidogrel group (9.7 versus 10.6 %, OR 0.92, 95 % CI 0.85–1.00). Use of recently introduced new ADP receptor antagonists results in a reduction in adverse clinical outcomes but a substantial increase in bleeding. New agents revealed an improved combined efficacy and safety outcome compared to that of clopidogrel in patients with CAD.

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Acknowledgments

This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIP) (No. R13-2007-023-00000-0).

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None of the authors have a conflict of interest.

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Authors and Affiliations

  1. Department of Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea

    Jong Seok Bae

  2. Cardiovascular Outcomes Research, Saint Luke’s Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, MO, USA

    Jae-Sik Jang

  3. Department of Cardiology, Busan Paik Hospital, Inje University College of Medicine, 633-165 Gaegum-dong, Jin-gu, Busan, 614-735, Korea

    Jae-Sik Jang

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Correspondence to Jae-Sik Jang.

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380_2014_601_MOESM1_ESM.pdf

Supplementary Fig. 1. Forest plot of ORs comparing new ADP receptor antagonists versus clopidogrel for (A) MI, (B) stent thrombosis, and (C) stroke stratified by the study agents

Supplementary Fig. 2. Forest plot of ORs comparing new ADP receptor antagonists versus clopidogrel for CABG related major bleeding

Supplementary Fig. 3. Forest plot of ORs comparing new ADP receptor antagonists versus clopidogrel for major or minor bleeding not related to CABG (PDF 1153 kb)

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Bae, J.S., Jang, JS. Comparison of new adenosine diphosphate receptor antagonists with clopidogrel in patients with coronary artery disease: a meta-analysis. Heart Vessels 31, 275–287 (2016). https://doi.org/10.1007/s00380-014-0601-9

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