Avik Ray1, Ahmad Najmi2, Gaurav Khandelwal3, Ratinder Jhaj2, Balakrishnan Sadasivam2. 1. Department of Pharmacology, All India Institute of Medical Sciences Bhopal, Bhopal, Madhya Pradesh, 462020, India. avik.jrpharma18@aiimsbhopal.edu.in. 2. Department of Pharmacology, All India Institute of Medical Sciences Bhopal, Bhopal, Madhya Pradesh, 462020, India. 3. Department of Cardiology, All India Institute of Medical Sciences Bhopal, Bhopal, Madhya Pradesh, 462020, India.
Abstract
PURPOSE: Dual antiplatelet therapy (DAPT) with aspirin and ticagrelor or prasugrel is the mainstay of treatment for patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). We aimed to systematically perform a head-to-head comparison of ticagrelor vs prasugrel in terms of efficacy and safety. METHODS: We searched PubMed/Medline, EMBASE and Cochrane Central Register of Controlled Trials (CENTRAL) for relevant published randomized controlled trials (RCTs). The primary outcome was adverse cardiovascular events and secondary outcome was bleeding events. A random-effects meta-analysis was used to obtain the pooled estimate of each outcome. RESULTS: Nine RCTs with a total number of 6990 patients (3550 treated with prasugrel and 3481 treated with ticagrelor) were included. No significant difference between prasugrel and ticagrelor was observed in terms of mortality (OR 0.86, 95% CI 0.66 to 1.13, P = 0.28), major adverse cardiovascular events (MACEs) (OR 0.85, 95% CI 0.70 to 1.03, P = 0.10), non-fatal myocardial infarction (OR 0.78, 95% CI 0.57 to 1.06, P = 0.11), stroke (OR 1.02, 95% CI 0.60 to 1.72, P = 0.95), stent thrombosis (OR 0.76, 95% CI 0.47 to 1.21, P = 0.25), thrombolysis in myocardial infarction (TIMI) defined major (OR 0.94, 95% CI 0.19 to 4.67, P = 0.94), minor (OR 0.35, 95% CI 0.08 to 1.62, P = 0.18) and minimal (OR 0.48, 95% CI 0.19 to 1.18, P = 0.11) bleeding and Bleeding Academic Research Consortium (BARC) defined bleeding (OR 1.06, 95% CI 0.82 to 1.36, P = 0.68). CONCLUSION: In patients with ACS undergoing PCI, both prasugrel and ticagrelor were associated with similar cardiovascular outcomes and adverse bleeding events.
PURPOSE: Dual antiplatelet therapy (DAPT) with aspirin and ticagrelor or prasugrel is the mainstay of treatment for patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). We aimed to systematically perform a head-to-head comparison of ticagrelor vs prasugrel in terms of efficacy and safety. METHODS: We searched PubMed/Medline, EMBASE and Cochrane Central Register of Controlled Trials (CENTRAL) for relevant published randomized controlled trials (RCTs). The primary outcome was adverse cardiovascular events and secondary outcome was bleeding events. A random-effects meta-analysis was used to obtain the pooled estimate of each outcome. RESULTS: Nine RCTs with a total number of 6990 patients (3550 treated with prasugrel and 3481 treated with ticagrelor) were included. No significant difference between prasugrel and ticagrelor was observed in terms of mortality (OR 0.86, 95% CI 0.66 to 1.13, P = 0.28), major adverse cardiovascular events (MACEs) (OR 0.85, 95% CI 0.70 to 1.03, P = 0.10), non-fatal myocardial infarction (OR 0.78, 95% CI 0.57 to 1.06, P = 0.11), stroke (OR 1.02, 95% CI 0.60 to 1.72, P = 0.95), stent thrombosis (OR 0.76, 95% CI 0.47 to 1.21, P = 0.25), thrombolysis in myocardial infarction (TIMI) defined major (OR 0.94, 95% CI 0.19 to 4.67, P = 0.94), minor (OR 0.35, 95% CI 0.08 to 1.62, P = 0.18) and minimal (OR 0.48, 95% CI 0.19 to 1.18, P = 0.11) bleeding and Bleeding Academic Research Consortium (BARC) defined bleeding (OR 1.06, 95% CI 0.82 to 1.36, P = 0.68). CONCLUSION: In patients with ACS undergoing PCI, both prasugrel and ticagrelor were associated with similar cardiovascular outcomes and adverse bleeding events.
Authors: Roxana Mehran; Sunil V Rao; Deepak L Bhatt; C Michael Gibson; Adriano Caixeta; John Eikelboom; Sanjay Kaul; Stephen D Wiviott; Venu Menon; Eugenia Nikolsky; Victor Serebruany; Marco Valgimigli; Pascal Vranckx; David Taggart; Joseph F Sabik; Donald E Cutlip; Mitchell W Krucoff; E Magnus Ohman; Philippe Gabriel Steg; Harvey White Journal: Circulation Date: 2011-06-14 Impact factor: 29.690
Authors: Ezra A Amsterdam; Nanette K Wenger; Ralph G Brindis; Donald E Casey; Theodore G Ganiats; David R Holmes; Allan S Jaffe; Hani Jneid; Rosemary F Kelly; Michael C Kontos; Glenn N Levine; Philip R Liebson; Debabrata Mukherjee; Eric D Peterson; Marc S Sabatine; Richard W Smalling; Susan J Zieman Journal: J Am Coll Cardiol Date: 2014-09-23 Impact factor: 24.094
Authors: Glenn N Levine; Eric R Bates; John A Bittl; Ralph G Brindis; Stephan D Fihn; Lee A Fleisher; Christopher B Granger; Richard A Lange; Michael J Mack; Laura Mauri; Roxana Mehran; Debabrata Mukherjee; L Kristin Newby; Patrick T O'Gara; Marc S Sabatine; Peter K Smith; Sidney C Smith Journal: J Am Coll Cardiol Date: 2016-03-29 Impact factor: 24.094
Authors: Stefanie Schüpke; Franz-Josef Neumann; Maurizio Menichelli; Katharina Mayer; Isabell Bernlochner; Jochen Wöhrle; Gert Richardt; Christoph Liebetrau; Bernhard Witzenbichler; David Antoniucci; Ibrahim Akin; Lorenz Bott-Flügel; Marcus Fischer; Ulf Landmesser; Hugo A Katus; Dirk Sibbing; Melchior Seyfarth; Marion Janisch; Duino Boncompagni; Raphaela Hilz; Wolfgang Rottbauer; Rainer Okrojek; Helge Möllmann; Willibald Hochholzer; Angela Migliorini; Salvatore Cassese; Pasquale Mollo; Erion Xhepa; Sebastian Kufner; Axel Strehle; Stefan Leggewie; Abdelhakim Allali; Gjin Ndrepepa; Helmut Schühlen; Dominick J Angiolillo; Christian W Hamm; Alexander Hapfelmeier; Ralph Tölg; Dietmar Trenk; Heribert Schunkert; Karl-Ludwig Laugwitz; Adnan Kastrati Journal: N Engl J Med Date: 2019-09-01 Impact factor: 91.245
Authors: Zuzana Motovska; Ota Hlinomaz; Roman Miklik; Milan Hromadka; Ivo Varvarovsky; Jaroslav Dusek; Jiri Knot; Jiri Jarkovsky; Petr Kala; Richard Rokyta; Frantisek Tousek; Petra Kramarikova; Bohumil Majtan; Stanislav Simek; Marian Branny; Jan Mrozek; Pavel Cervinka; Jiri Ostransky; Petr Widimsky Journal: Circulation Date: 2016-08-30 Impact factor: 29.690
Authors: Zuzana Motovska; Ota Hlinomaz; Petr Kala; Milan Hromadka; Jiri Knot; Ivo Varvarovsky; Jaroslav Dusek; Jiri Jarkovsky; Roman Miklik; Richard Rokyta; Frantisek Tousek; Petra Kramarikova; Michal Svoboda; Bohumil Majtan; Stanislav Simek; Marian Branny; Jan Mrozek; Pavel Cervinka; Jiri Ostransky; Petr Widimsky Journal: J Am Coll Cardiol Date: 2017-11-14 Impact factor: 24.094
Authors: Robert C Welsh; Robinder S Sidhu; John A Cairns; Shahar Lavi; Sasko Kedev; Raul Moreno; Warren J Cantor; Goran Stankovic; Brandi Meeks; Fei Yuan; Vladimír Džavík; Sanjit S Jolly Journal: Can J Cardiol Date: 2019-05-07 Impact factor: 5.223
Authors: Marco Roffi; Carlo Patrono; Jean-Philippe Collet; Christian Mueller; Marco Valgimigli; Felicita Andreotti; Jeroen J Bax; Michael A Borger; Carlos Brotons; Derek P Chew; Baris Gencer; Gerd Hasenfuss; Keld Kjeldsen; Patrizio Lancellotti; Ulf Landmesser; Julinda Mehilli; Debabrata Mukherjee; Robert F Storey; Stephan Windecker Journal: Eur Heart J Date: 2015-08-29 Impact factor: 29.983
Authors: Ioannis T Farmakis; Stefanos Zafeiropoulos; Ioannis Doundoulakis; Areti Pagiantza; Efstratios Karagiannidis; Dimitrios V Moysidis; Nikolaos Stalikas; George Kassimis; Lampros K Michalis; Haralambos Karvounis; George Giannakoulas Journal: Open Heart Date: 2022-04