Key result
Prasugrel had similar risks of all-cause death (RR 0.83; 95% CI 0.64-1.06) compared to clopidogrel in ACS patients, but significantly increased total major and minor bleeding (RR 1.30; P<0.0001).
Why the study?
Does prasugrel reduce death, MI, stroke, or stent thrombosis compared to clopidogrel in patients with acute coronary syndrome?
Meta-Analysis
Does prasugrel reduce death, MI, stroke, or stent thrombosis compared to clopidogrel in patients with acute coronary syndrome?
In patients with ACS, prasugrel reduces stent thrombosis in those undergoing PCI but increases bleeding risk without significantly reducing death, MI, or stroke compared to clopidogrel.
Answers are grounded in this paper and cite their sources.
Similar mortality but higher bleeding with prasugrel versus clopidogrel in ACS; challenges routine preference and extends bleeding trade-off evidence.
BACKGROUND: Whether prasugrel can take the place of clopidogrel for patients with acute coronary syndrome (ACS) is not clear. The aim of this study was to perform a meta-analysis for systematically reviewing the evidence on prasugrel in comparison to clopidogrel in patients with ACS. MATERIAL/METHODS: Relevant prospective and retrospective studies were searched in databases. Six studies were finally included. Pooled risk ratios (RRs) and 95% confidence intervals (CIs) were calculated to assess all causes of death, myocardial infarction (MI), stroke, major bleeding, major/minor bleeding, and stent thrombosis (for PCI performed). RESULTS: Compared with clopidogrel, prasugrel had similar risks of all cause of death (Pooled RR: 0.83; 95% CI: 0.64-1.06, p=0.14, I2=55%), MI (Pooled RR: 0.86; 95% CI: 0.71-1.04, p=0.12) and stroke (pooled RR: 0.88; 95% CI: 0.70-1.10, p=0.25). However, prasugrel was associated with significantly higher risk of both major bleeding (Pooled RR: 1.19; 95% CI: 0.99-1.44, p=0.06, I2=0%) and the risk of total major and minor bleeding (Pooled RR: 1.30; 95% CI: 1.15-1.48, p<0.0001, I2=0%). For the patients who underwent percutaneous coronary intervention (PCI), prasugrel was associated with significantly lower risk of stent thrombosis (Pooled RR: 0.47; 95% CI: 0.34-0.61, p<0.00001, I2=0%). CONCLUSIONS: Prasugrel has similar effects as clopidogrel in terms of all causes of death, MI, and stroke in ACS patients. For the patients who underwent PCI, prasugrel contributes to lower risk of stent thrombosis. However, prasugrel is associated with significantly higher risk of bleeding. For the patients with active pathological bleeding or a history of stroke and/or TIA, prasugrel should not be recommended.
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Keyong Chen (2015) conducted a meta-analysis in Acute Coronary Syndrome. Prasugrel vs. Clopidogrel was evaluated on All causes of death (RR 0.83, 95% CI 0.64-1.06, p=0.14). Prasugrel had similar risks of all-cause death (RR 0.83; 95% CI 0.64-1.06) compared to clopidogrel in ACS patients, but significantly increased total major and minor bleeding (RR 1.30; P<0.0001).
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