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Prasugrel vs. Ticagrelor for Acute Coronary Syndrome Patients Undergoing Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis.

Publication ,  Journal Article
Khan, MS; Memon, MM; Usman, MS; Alnaimat, S; Khan, SU; Khan, AR; Yamani, N; Fugar, S; Mookadam, F; Krasuski, RA; Doukky, R
Published in: Am J Cardiovasc Drugs
October 2019

BACKGROUND: The newer P2Y12 inhibitors have better efficacy than clopidogrel. However, whether ticagrelor or prasugrel have a better comparative safety and efficacy profile, especially in the long-term, remains inconclusive. OBJECTIVE: We compared prasugrel and ticagrelor in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). METHODS: MEDLINE and the Cochrane library were queried for randomized controlled trials (RCTs) or observational studies comparing prasugrel with ticagrelor in patients with ACS undergoing PCI. Random-effects pooling was used to calculate odds ratios (ORs) with 95% confidence intervals (CI). Analyses were stratified by duration of follow-up (short term [≤ 3 months] and long term [≥ 1 year]) and study design. RESULTS: In total, 14 studies (six RCTs, eight observational studies), including 40,188 patients, met eligibility criteria. Pooled analysis did not indicate that prasugrel significantly decreased all-cause mortality compared with ticagrelor in the short term (OR 0.49; 95% CI 0.20-1.20; p = 0.11) or long term (OR 0.74; 95% CI 0.48-1.15; p = 0.38). Pooled observational studies showed significantly lower long-term all-cause mortality (OR 0.63; 95% CI 0.43-0.92; p = 0.02) and short-term stent thrombosis (OR 0.46; 95% CI 0.28-0.75; p = 0.002) with prasugrel. No significant difference was observed in the risk of nonfatal myocardial infarction, ischemic stroke, bleeding, or repeat revascularization between the two groups. Results remained similar after stratification according to follow-up and study design. CONCLUSIONS: The present analysis suggests that prasugrel might have a better efficacy profile than ticagrelor in patients with ACS undergoing PCI. However, this advantage was only seen in pooled observational studies and is likely to be affected by selection bias.

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Published In

Am J Cardiovasc Drugs

DOI

EISSN

1179-187X

Publication Date

October 2019

Volume

19

Issue

5

Start / End Page

465 / 476

Location

New Zealand

Related Subject Headings

  • Ticagrelor
  • Prasugrel Hydrochloride
  • Platelet Aggregation Inhibitors
  • Percutaneous Coronary Intervention
  • Observational Studies as Topic
  • Humans
  • Cardiovascular System & Hematology
  • Acute Coronary Syndrome
  • 3201 Cardiovascular medicine and haematology
  • 1102 Cardiorespiratory Medicine and Haematology
 

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Khan, M. S., Memon, M. M., Usman, M. S., Alnaimat, S., Khan, S. U., Khan, A. R., … Doukky, R. (2019). Prasugrel vs. Ticagrelor for Acute Coronary Syndrome Patients Undergoing Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis. Am J Cardiovasc Drugs, 19(5), 465–476. https://doi.org/10.1007/s40256-019-00337-5
Khan, Muhammad Shahzeb, Muhammad Mustafa Memon, Muhammad Shariq Usman, Saed Alnaimat, Safi U. Khan, Abdur Rahman Khan, Naser Yamani, et al. “Prasugrel vs. Ticagrelor for Acute Coronary Syndrome Patients Undergoing Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis.Am J Cardiovasc Drugs 19, no. 5 (October 2019): 465–76. https://doi.org/10.1007/s40256-019-00337-5.
Khan MS, Memon MM, Usman MS, Alnaimat S, Khan SU, Khan AR, et al. Prasugrel vs. Ticagrelor for Acute Coronary Syndrome Patients Undergoing Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis. Am J Cardiovasc Drugs. 2019 Oct;19(5):465–76.
Khan, Muhammad Shahzeb, et al. “Prasugrel vs. Ticagrelor for Acute Coronary Syndrome Patients Undergoing Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis.Am J Cardiovasc Drugs, vol. 19, no. 5, Oct. 2019, pp. 465–76. Pubmed, doi:10.1007/s40256-019-00337-5.
Khan MS, Memon MM, Usman MS, Alnaimat S, Khan SU, Khan AR, Yamani N, Fugar S, Mookadam F, Krasuski RA, Doukky R. Prasugrel vs. Ticagrelor for Acute Coronary Syndrome Patients Undergoing Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis. Am J Cardiovasc Drugs. 2019 Oct;19(5):465–476.
Journal cover image

Published In

Am J Cardiovasc Drugs

DOI

EISSN

1179-187X

Publication Date

October 2019

Volume

19

Issue

5

Start / End Page

465 / 476

Location

New Zealand

Related Subject Headings

  • Ticagrelor
  • Prasugrel Hydrochloride
  • Platelet Aggregation Inhibitors
  • Percutaneous Coronary Intervention
  • Observational Studies as Topic
  • Humans
  • Cardiovascular System & Hematology
  • Acute Coronary Syndrome
  • 3201 Cardiovascular medicine and haematology
  • 1102 Cardiorespiratory Medicine and Haematology