Why the study?
Do P2Y12 inhibitors reduce MACE in both women and men with acute coronary syndromes?
Meta-Analysis (n=107,126)
Do P2Y12 inhibitors reduce MACE in both women and men with acute coronary syndromes?
Relative Risk: 0.79 (95% CI 0.68–0.92)
p-value: p=0.003
This meta-analysis demonstrates that P2Y12 inhibitors reduce MACE in both men and women with acute coronary syndromes, with ticagrelor showing consistent superiority over clopidogrel across both sexes.
Ticagrelor may benefit women more than prasugrel; leaves open sex-specific P2Y12 selection pending randomized data.
BACKGROUND AND OBJECTIVES: The majority of patients included in trials of anti-platelet therapy are male. This systematic review and meta-analysis aimed to determine whether, in addition to aspirin, P2Y12 blockade is beneficial in both women and men with acute coronary syndromes. METHODS: Electronic databases were searched and nine eligible randomised controlled studies were identified that had sex-specific clinical outcomes (n=107,126 patients). Risk Ratios (RR) and 95% Confidence Intervals (CI) were calculated for a composite of cardiovascular death, myocardial infarction or stroke (MACE), and a safety endpoint of major bleeding for each sex. Indirect comparison analysis was performed to statistically compare ticagrelor against prasugrel. RESULTS: Compared to aspirin alone, clopidogrel reduced MACE in men (RR, 0.79; 95% CI, 0.68 to 0.92; p=0.003), but was not statistically significant in women (RR, 0.88; 95% CI, 0.75 to 1.02, p=0.08). Clopidogrel therapy significantly increased bleeding in women but not men. Compared to clopidogrel, prasugrel was beneficial in men (RR, 0.84; 95% CI, 0.73 to 0.97; p=0.02) but not statistically significant in women (RR, 0.94; 95% CI, 0.83 to 1.06; p=0.30); ticagrelor reduced MACE in both men (RR, 0.85; 95% CI, 0.77 to 0.94; p=0.001) and women (RR, 0.84; 95% CI, 0.73 to 0.97; p=0.02). Indirect comparison demonstrated no significant difference between ticagrelor and prasugrel in either sex. Compared to clopidogrel, ticagrelor and prasugrel increased bleeding risk in both women and men. CONCLUSION: In summary, in comparison to monotherapy with aspirin, P2Y12 inhibitors reduce MACE in women and men. Ticagrelor was shown to be superior to clopidogrel in both sexes. Prasugrel showed a statistically significant benefit only in men; however indirect comparison did not demonstrate superiority of ticagrelor over prasugrel in women.
No takes yet. Share an insight, caveat, or question.
Brown et al. (2018) conducted a meta-analysis in acute coronary syndromes (n=107,126). P2Y12 inhibitors vs. aspirin alone or clopidogrel was evaluated on composite of cardiovascular death, myocardial infarction or stroke (MACE) (RR 0.79, 95% CI 0.68 to 0.92, p=0.003).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: