Key result
Clopidogrel was not associated with a different risk of major bleeding compared to ticagrelor in acute coronary syndrome patients treated with coronary artery bypass grafting.
Why the study?
The use of DAPT in ACS patients treated with CABG remains controversial, and previous evidence regarding major bleeding risk with clopidogrel versus ticagrelor was inconclusive.
Does ticagrelor compared to clopidogrel affect the risk of major bleeding in ACS patients treated with CABG?
Meta-Analysis (n=66,676)
Does ticagrelor compared to clopidogrel affect the risk of major bleeding in ACS patients treated with CABG?
In patients with acute coronary syndrome undergoing coronary artery bypass grafting, the choice of P2Y12 inhibitor (ticagrelor vs. clopidogrel) does not significantly affect the risk of major bleeding.
Answers are grounded in this paper and cite their sources.
No excess major bleeding supports flexible P2Y12 choice in ACS-CABG; leaves open optimal agent pending RCTs.
<ns3:p> <ns3:bold>Background:</ns3:bold> There is controversy among physicians regarding the use of dual antiplatelet therapy (DAPT) in acute coronary syndrome (ACS) patients treated with coronary artery bypass grafting (CABG). Moreover, the evidence of previous studies about this topic remained inconclusive. This study aimed to perform a meta-analysis concerning the relation between the risk of major bleeding and the use of different DAPT (clopidogrel or ticagrelor) in ACS patients treated with CABG. </ns3:p> <ns3:p> <ns3:bold>Methods:</ns3:bold> A meta-analysis was conducted during March to October 2019. Searches were carried out in Pubmed, Embase, Cochrane, and Web of Science. The predictor covariate in our present study was DAPT (clopidogrel or ticagrelor), and the outcome measure was the risk of major bleeding. Sub-group analysis was also performed, where data were classified into pre- and post-CABG. Furthermore, to determine the correlation and effect estimation, data were analyzed using fixed or random effect model. </ns3:p> <ns3:p> <ns3:bold>Results:</ns3:bold> A total of 13 studies consisting 34,015 patients treated with clopidogrel and 32,661 patients treated with ticagrelor was included in our study. Our pooled calculation revealed that the incidence of major bleeding was not different significantly between clopidogrel and ticagrelor. In pre- and post-CABG sub-groups, our results also found no significant difference in major bleeding incidence between clopidogrel and ticagrelor groups. </ns3:p> <ns3:p> <ns3:bold>Conclusions:</ns3:bold> Our meta-analysis clarifies that clopidogrel, compared to ticagrelor, or vice versa, is not associated with the risk of major bleeding in ACS patients treated with CABG. </ns3:p>
No takes yet. Share an insight, caveat, or question.
Rohman et al. (2020) conducted a meta-analysis in Acute coronary syndrome (ACS) treated with coronary artery bypass grafting (CABG) (n=66,676). Clopidogrel vs. Ticagrelor was evaluated on Incidence of major bleeding (OR 1.10, 95% CI 0.98-1.24, p=0.0990). Clopidogrel was not associated with a different risk of major bleeding compared to ticagrelor in acute coronary syndrome patients treated with coronary artery bypass grafting.
Synapse has enriched 10 related papers. Consider them for comparative context: