Key result
New oral antiplatelet regimens reduce mortality ~13% vs standard-dose clopidogrel in ACS.
Why the study?
The benefits of new oral antiplatelet regimens blocking platelet ADP-receptors compared to standard-dose clopidogrel in ACS patients were not fully established.
Do new oral antiplatelet regimens reduce mortality compared to standard-dose clopidogrel in patients with acute coronary syndromes?
Meta-Analysis (n=58,591)
Do new oral antiplatelet regimens reduce mortality compared to standard-dose clopidogrel in patients with acute coronary syndromes?
Odds Ratio: 0.87 (95% CI 0.79–0.95)
Absolute Event Rate: 2.9% vs 3.4%
p-value: p=0.002
Newer oral antiplatelet regimens (prasugrel or ticagrelor) significantly reduce mortality, reinfarction, and in-stent thrombosis in ACS patients without increasing major bleeding compared to standard-dose clopidogrel.
Supports preferring prasugrel or ticagrelor over clopidogrel in ACS; confirms mortality benefit in meta-analysis of randomized trials.
BACKGROUND: Platelets play a pivotal role in the pathogenesis of acute coronary syndromes (ACS) and their inhibition remains a mainstay therapy in this setting. We aimed to perform a meta-analysis of randomized trials to evaluate the benefits of new oral antiplatelet regimens to block platelet ADP-receptors compared to standard-dose clopidogrel (300 mg loading dose followed by 75 mg/daily). METHODS: We obtained results from all randomized trials enrolling patients with ACS. Primary endpoint was mortality. Secondary endpoints were myocardial infarction and definite in-stent thrombosis. Safety endpoint was the risk of major bleeding complications. We prespecified subanalyses according to new antiplatelet drugs (prasugrel/ticagrelor), high-dose clopidogrel (600 mg) and patients undergoing percutaneous coronary intervention. RESULTS: A total of seven randomized trials were finally included in the meta-analysis (n = 58 591). We observed a significant reduction in mortality (2.9% vs. 3.4%, OR = 0.87, 95% CI 0.79-0.95, P = 0.002), recurrent myocardial infarction (4.2% vs. 5.2%, OR = 0.80, 95% CI 0.74-0.87, P < 0.0001), definite in-stent thrombosis (0.9% vs. 1.7%, OR = 0.52, 95% CI 0.43-0.63, P < 0.0001). The benefits in mortality and reinfarction were driven by the treatment with prasugrel or ticagrelor, without a significant difference in terms of major bleeding complications as compared to standard-dose clopidogrel (5% vs. 4.7%, OR = 1.06 95% CI 0.96-1.17, P = 0.25). CONCLUSION: This meta-analysis showed that new oral antiplatelet regimens are associated with a significant reduction in mortality, reinfarction and in-stent thrombosis in ACS patients without an overall increase of major bleeding when treated with new antiplatelet drugs.
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Navarese et al. (2011) conducted a meta-analysis in Acute coronary syndromes (n=58,591). New oral antiplatelet regimens (prasugrel/ticagrelor) or high-dose clopidogrel vs. Standard-dose clopidogrel (300 mg loading dose followed by 75 mg/daily) was evaluated on Mortality (OR 0.87, 95% CI 0.79-0.95, p=0.002). New oral antiplatelet regimens significantly reduced mortality compared to standard-dose clopidogrel in patients with acute coronary syndromes (2.9% vs. 3.4%; OR 0.87; 95% CI 0.79-0.95; P=0.002).
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