Ischaemic and bleeding complications with new, compared to standard, ADP-antagonist regimens in acute coronary syndromes: a 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 ADPreceptors
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 standarddose
clopidogrel (5% vs. 4.7%, OR= 1.06 95% CI
0.96–1.17, P = 0.25).
Conclusions: 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
