Key result
Clopidogrel shows no difference versus ticagrelor for bleeding, stent thrombosis, or mortality in hypothermic PCI.
Why the study?
The efficacy of antiplatelet drugs such as clopidogrel and ticagrelor after PCI in patients managed with therapeutic hypothermia has been debated.
Does ticagrelor improve clinical outcomes (bleeding, stent thrombosis, mortality) compared to clopidogrel in PCI patients managed with therapeutic hypothermia?
Meta-Analysis (n=245)
Does ticagrelor improve clinical outcomes (bleeding, stent thrombosis, mortality) compared to clopidogrel in PCI patients managed with therapeutic hypothermia?
In patients undergoing PCI and managed with therapeutic hypothermia, there appears to be no significant difference in clinical outcomes between clopidogrel and ticagrelor, though data is limited.
Answers are grounded in this paper and cite their sources.
No difference in bleeding, stent thrombosis, or mortality between clopidogrel and ticagrelor; challenges claims of altered clopidogrel efficacy under TH but leaves open need for larger RCTs.
Various antiplatelet drugs, such as clopidogrel and ticagrelor, are available on the market for use after percutaneous coronary intervention (PCI). However, the efficacy of such drugs in patients being managed with therapeutic hypothermia (TH) has always been debated. In light of this controversy, this systematic review and meta-analysis was performed to enhance existing literature. Various databases were searched for potentially relevant studies from inception to April 2023, including PubMed, Cochrane Library, and Scopus. The risk of bias was assessed using the Newcastle-Ottawa scale for cohort studies and the Cochrane risk of bias tool for randomized controlled trials. Outcomes of interest included risk of bleeding, stent thrombosis, and all-cause mortality. Five studies were shortlisted for inclusion into the meta-analysis, featuring a total of 245 patients receiving either clopidogrel or ticagrelor. Overall, no significant differences were noted when the use of clopidogrel and ticagrelor was compared in PCI patients being managed with TH. To the best of our knowledge, this is the most comprehensive meta-analysis comparing the outcomes of clopidogrel and ticagrelor in PCI patients being managed with TH. Despite existing studies claiming an altered efficacy of clopidogrel in such conditions, our meta-analytic findings could not prove this relationship. Due to the limited sample size, further comprehensive and randomized studies are encouraged to arrive at a robust conclusion.
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Sajid et al. (2023) conducted a meta-analysis in Percutaneous coronary intervention (PCI) managed with therapeutic hypothermia (n=245). Clopidogrel vs. Ticagrelor was evaluated on Risk of bleeding, stent thrombosis, and all-cause mortality. In a meta-analysis of 245 patients, clopidogrel showed no significant differences compared to ticagrelor for bleeding, stent thrombosis, and mortality in PCI patients managed with hypothermia.
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