Key result
Adding clopidogrel (OR 0.42; 95% CrI 0.22-0.76) or ticagrelor 90 mg (OR 0.42; 95% CrI 0.17-0.95) to aspirin reduced myocardial infarction compared to aspirin alone in chronic coronary syndromes.
Why the study?
The study was conducted to explore the efficacy and safety of different antiplatelet or anticoagulation drugs in chronic coronary syndromes patients.
Do different antiplatelet or anticoagulation drugs improve cardiovascular outcomes or increase bleeding in patients with chronic coronary syndromes?
Meta-Analysis
Do different antiplatelet or anticoagulation drugs improve cardiovascular outcomes or increase bleeding in patients with chronic coronary syndromes?
In chronic coronary syndromes, adding clopidogrel or ticagrelor 90 mg to aspirin reduces myocardial infarction, but dual therapy with clopidogrel/prasugrel or rivaroxaban 2.5 mg increases major bleeding without a significant difference in overall MACE.
Answers are grounded in this paper and cite their sources.
Supports targeted DAPT with clopidogrel or ticagrelor in CCS for MI prevention; extends network evidence on antithrombotic trade-offs.
BACKGROUND: A systematic review and network meta-analysis (NMA) were conducted to explore the efficacy and safety of different antiplatelet or anticoagulation drugs in chronic coronary syndromes patients. METHODS: Electronic databases (Pubmed, Embase and Cochrane databases) were systematically searched to identify randomized controlled trials evaluating different antiplatelet or anticoagulation drugs (aspirin, aspirin + clopidogrel, aspirin + clopidogrel + cilostazol, clopidogrel/prasugrel + aspirin, aspirin + rivaoxaban 2.5 mg, aspirin + ticagrelor 60 mg, aspirin + ticagrelor 90 mg, clopidogrel or rivroxaban 5 mg) versus placebo for treatment chronic coronary syndromes patients. Outcomes included major adverse cardiovascular events, all cause death, major bleeding and myocardial infarction. A random-effect Bayesian NMA was conducted for outcomes of interest, and results were presented as odds ratios (ORs) and 95% credible intervals. The NMA was performed using R Software with a GeMTC package. A Bayesian NMA was performed and relative ranking of agents was assessed using surface under the cumulative ranking probabilities. RESULTS: Ten randomized controlled trials met criteria for inclusion and finally included in this NMA. In head-to-head comparison, no significant difference was observed between all antithrombotic treatment strategies with respect to primary endpoint of major adverse cardiovascular events. In head-to-head comparison, no significant difference was observed between all antithrombotic treatment strategies with respect to all cause death. Clopidogrel/prasugrel + aspirin (OR = 3.8, 95% credible intervals [CrI]: 1.3-12.0, P < .05) and aspirin + rivaroxaban 2.5 mg (OR = 3.1, 95%CrI: 1.1-9.5, P < .05) was associated with an increase of the major bleeding. Compared with aspirin alone, aspirin + clopidogrel (OR = 0.42, 95%CrI: 0.22-0.76, P < .05) and aspirin + ticagrelor 90 mg (OR = 0.42, 95%CrI: 0.17-0.95, P < .05) was associated with a decrease of the myocardial infarction. CONCLUSIONS: Myocardial infarction was significantly lower when adding clopidogrel or ticagrelor 90 mg to aspirin than those in the aspirin alone group. However, clopidogrel/prasugrel and rivaroxaban 2.5 mg was associated with an increase of the major bleeding than aspirin alone.
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Liu et al. (2023) conducted a meta-analysis in chronic coronary syndromes. antiplatelet or anticoagulation drugs vs. placebo or aspirin alone was evaluated on major adverse cardiovascular events. Adding clopidogrel (OR 0.42; 95% CrI 0.22-0.76) or ticagrelor 90 mg (OR 0.42; 95% CrI 0.17-0.95) to aspirin reduced myocardial infarction compared to aspirin alone in chronic coronary syndromes.
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